陈旧性齿状突骨折伴迟发性脊髓损伤的临床研究

A clinical study of old odontoid fracture combined with tardive spinal cord lesion

目的探讨陈旧性齿状突骨折与迟发性脊髓损伤的关系及其临床诊治特点和方法。方法回顾性分析2001年3月～2005年5月收治的23例陈旧性齿状突骨折伴迟发性脊髓损伤患者。根据Anderson和D’Alonzo分型：Ⅱ型骨折19例(83%),Ⅲ型骨折4例(17%)。术前均进行了颅骨牵引术,可完全复位12例(52%),可部分复位5例(22%),不可复位6例(26%)。术前JOA评分为3～12分(平均8．5分)。23例均进行了手术治疗,4例先进行了经口减压松解术。对能够满意复位且神经症状明显缓解或消失者予以寰枢椎融合术,本组15例；对不能满意复位或症状不能缓解者予以寰椎后弓切除减压加枕颈融合术,本组8例。结果23例均获得临床随访,时间1～4年,平均2年9个月。22例获得坚强骨性融合,1例未融合(枕颈融合术),融合率为95．6%；术后JOA评分为11～17分(平均14．5分),术后平均改善率为78．2%。结论陈旧性齿状突骨折造成寰枢椎脱位或不稳定,容易导致继发性脊髓损伤。尽早手术干预是治疗的主要方式,积极地进行有效的脊髓减压加可靠的寰枢椎或枕颈融合术,临床效果良好。

Objective To discuss the clinical diagnosis and treatment of old odontoid fractures combined with tardive spinal cord lesion. Methods Twenty-three patients who had been treated from March 2001 to May 2005 for old odontoid fracture and tardive spinal cord lesion were retrospectively studied. Of them, 19 were type Ⅱ of odontoid fracture （83%）, and four type Ⅲ （17%）. In the preoperative skull traction for all patients, 12 cases were completely reduced （52%）, five partially reduced （22%）, and six not reduced at all （26%） . Their JOA （Japanese Orthopaedic Association） scores before surgical procedure ranged from 3 to 12 points, with an average of 8.5. Four cases of them received operative decompression and release through transoral approach prior to posterior approach, 15 patients got C1-C2 posterior fusion with iliac crest bone graft, and eight patients underwent occipito- cervical fusion with resection of posterior atlantal arch. Results All the 23 patients were followed up for 1 to 4 years, with an average of two years and nine months. Solid bony fusion was achieved in 22 patients but non-union occurred in one case who had occipitocervical fusion. The rate of fusion was 95.6%. JOA scores after operation were recorded from 11 to 17 （mean, 14. 5）. The overall improvement rate was 78. 2% on average. Conclusions Old odontoid fractures often result in atlantoaxial dislocation or instability which is likely to lead to tardive spinal cord lesion. Therefore it is important to have early surgical intervention. Good clinical results can be achieved by active and effective decompression of spinal cord and atlantoaxial or occipitocervical solid fusion.