经口咽前路寰枢椎复位钢板系统在陈旧性齿状突骨折治疗中的应用(英文)

Application of transoralpharyngeal atlantoaxial reduction plate system in the treatment of obsolete odontoid fracture

背景:对颅颈交界区畸形及其他病变引起的寰枢椎脱位伴脊髓压迫症需减压内固定,可根据不同的情况选择不同的内固定方法,包括寰枢前路内固定、寰枢后路内固定或枕颈内固定。经口咽前路寰枢椎钢板内固定是新近发展起来的一种寰枢椎前路固定方法,用于先天性疾患、外伤或类风湿性关节炎等所致的难复性寰枢椎脱位。目的:探讨经口咽前路寰枢椎复位钢板系统在陈旧性齿状突骨折引起的寰枢椎脱位的临床应用。设计:单一样本观察。单位:解放军广州军区广州总医院骨科。对象:选择解放军广州军区广州总医院骨科2003-01/2005-11因陈旧性齿突骨折引起的寰枢椎脱位患者12例。男7例,女5例;年龄36～59岁,平均47岁;受伤时间4.5～36个月,平均19个月;Frank分级:C级6例,D级3例,E级3例。方法:对12例陈旧性齿状突骨折引起的寰枢椎脱位患者行经口咽前路松解减压,应用经口咽前路寰枢椎复位钢板系统复位和固定,两侧寰枢关节间植入自体髂骨融合。主要观察指标:①术后4周患者Frank分级。②术后内固定物是否有松动。结果:①术后4周Frank分级:原为C级的6例患者中4例改进为E级,2例改进为D级M原为D级的3例患者均改进为E级;原为E级的患者分级无改变。②除1例因跌倒引起螺钉松动再次脱位外,均固定牢固,融合理想,脊髓减压满意。结论:经口咽前路寰枢椎复位钢板系统一次完成寰枢椎脱位的复位和固定,避免了前路减压术后再行后路融合固定手术,避免在搬动、翻身过程中,因寰枢椎极度不稳可能对脊髓造成的致命的损伤。

BACKGROUND： Decompression-internal fixation is needed in the treatment of atlantoaxial dislocation accompanying with spinal compression caused by cranium-neck junction area malformation and other diseases. Different internal fixation methods are chosen according to different conditions, including anterior atlantoaxial internal fixation, posterior atlantoaxial internal fixation or occipitocervical internal fixation. Transoralpharyngeal atlantoaxial plate internal fixation is a method for atlantoaxial anterior fixation. It is developed recently and used for difficult and complicated atlantoaxial dislocation induced by congenital disease, trauma or rheumatoid arthritis. OBJECTIVE： To probe into the clinical application of transoralpharyngeal atlantoaxial reduction plate system in the atlantoaxial dislocation caused by obsolete odontoid fracture. DESIGN： Single Sample observation SETTING： Department of Orthopaedics, Guangzhou General Hospital of Guangzhou Military Medical University of Chinese PLA PARTICIPANTS： Twelve patients with atlantoaxial dislocation caused by obsolete odontoid fracture were selected in the Department of Orthopaedics, General Hospital of Guangzhou Military Medical University of Chinese PLA from January 2003 to October 2005. Among them, 7 were male arid 5 were female, they were aged 47 years on average ranging from 36 to 59 years. The mean injured time was 19 months ranging from 4.5 to 36 months; 6 patients were graded as C degree, 3 as D degree and 3 as E degree in Frank gradation. METHODS： Twelve obsolete odontoid fracture caused by atlantoaxial dislocation underwent transoralpharyngeal anterior decompression. Transoralpharyngeal atlantoaxial reduction plate system was used in reduction and fixation. Autogeneic ilium was implanted into bilateral articulatio atlantoepistrophica. MAIN OUTCOME MEASURES： ①Frank gradation of patients at the 4^th week after operation. ② whether the internal fixation is loose or not after operation RESULTS： ①Frank gradation at the 4^th week after operation： Among the 6 patients who were primarily graded as C degree, 4 patients improved to be E degree and 2 patients D degree; Three patients who were primarily graded as D degree all improved to be E degree; Patients who were primarily graded as E degree did not changed. ② Except for one patient who suffered dislocation again for loosening of screw caused by tumble, the other patients had firm fixation, ideal fusion and satisfying spinal decompression. CONCLUSION： Transoralpharyngeal atlantoaxial reduction plate system finishes atlantoaxial reduction and fixation once. It avoids conducting posterior fusion fixation operation after anterior decompression. It also avoids fetal injury for spinal cord caused by extreme atlantoaxial unsteadiness in the process of movement and turning over.