齿状突骨折经皮螺钉内固定手术前后CT重建的意义

The application of CT reconstruction in percutaneous anterior screw fixation for odontoid fracture

目的:探讨齿状突骨折经皮螺钉内固定手术前后应用CT重建的意义。方法:16例齿状突骨折患者,术前进行上颈椎CT扫描及图像后处理,观察齿状突骨折的部位、骨折线走向及移位情况,并测量齿状突解剖学数据。均行经皮前路齿状突螺钉内固定术,术后不同时期同样进行CT重建,以观察齿状突骨折复位、螺钉内固定及骨折愈合等。结果:16例齿状突骨折患者中,AndersonⅡ型10例,其中EyselA型3例,B型2例,C型5例;AndersonⅢ型6例。齿状突基底冠状径8.7±1.1mm,矢状径10.9±1.1mm,齿状突骨折远段长度12.3±1.1mm,齿状突后倾角23.3°±1.2°;术后CT重建证实16例患者中,11例复位及螺钉位置良好,2例螺钉位置有偏斜,2例螺纹未完全通过骨折线,1例螺钉穿破齿状突尖部皮质。随访发现15例达到骨性愈合,1例EyselC型骨折经10个月随访仍未见到骨性愈合,继续随访观察中。结论:经皮前路螺钉内固定治疗齿状突骨折术前、术后行CT重建有利于准确评估骨折状况、制定周密手术方案及评价手术效果。

Objective:To explore the value of helical computed tomography scanning and image reconstruction for percutaneous anterior odontoid fixation.Method:16 cases with odontoid fracture were treated by percutaneous anterior screw fixation.CT scanning and image reconstruction were obtained to observe fracture type and fracture orientation,also anatomical data of odontoid process was measured preoperatively;postoperative CT scanning was used to analyse fracture reduction?screw fixation and bone fusion.Result:According to the criteria delineated by Anderson and D′Alonzo,there were 10 type Ⅱ cases and 6 type Ⅲ cases in all 16 cases.Among 10 type Ⅱ cases there were 3 type A cases?2 type B cases and 5 type C cases respectively according to Eysel′s criteria.The coronal external diameter of the base of odontoid process was 8.7±1.1mm,while the sagittal external diameter was 10.9±1.1mm,the length of the fractured distal odontoid fragment was 12.3±1.1mm and the posterior incline angle was 23.3°±1.2°.Postoperative CT reconstruction confirmed good fracture reduction and screw placement in 11 cases,divergent screw placement was founded in 2 cases,insufficient pass of stria in 2 cases and breakage of cortex of odontoit apex in 1 case.After a mean follow-up of 12.6 months,CT reconstruction showed bone union in 15 cases,including anatomical bone union 12 cases and nonanatomical bone union 3 cases,while nonunion in 1 case.Conclusion:Preoperative and postoperative CT reconstruction is favorable of evaluating fracture status accurately?making careful program of operation and assessing effect of operation.