前路单枚空心螺钉内固定术治疗齿状突骨折12例临床报道

Anterior single-screw fixation of odontoid fractures:a 12-case clinical report

目的回顾性评估12例齿状突骨折采用前路单枚空心螺钉内固定术治疗的临床疗效。方法从1999年2月-2007年2月采用前路单枚空心螺钉内固定术治疗AndersonⅡ型和Ⅲ型齿状突骨折共12例。所有患者术前牵引复位,术后均行头颈胸支具外固定3个月。结果随访时间6-72个月,平均24个月。1例齿状突骨折行单枚齿状突螺钉固定后骨折移位,骨折畸形愈合,无神经症状。其余11例患者经半年以上随访骨折获骨愈合,未出现内植物断裂或感染等并发症。5例神经功能障碍者均有不同程度改善。结论前路螺钉固定治疗齿状突骨折提供良好的稳定性同时保留寰枢关节运动功能,骨折愈合率较高,并发症低,是治疗AndersonⅡ型和浅Ⅲ型齿状突骨折的首选方法。

Objective To evaluate and analyse the clinical outcomes of anterior single screw fixation of odontoid fractures. Methods From Feb. 1999 to Feb. 2007,12 patients of type Ⅱ and shallow type Ⅲ odontoid fractures with or without spinal cord injury underwent anterior single-screw fixation. All patients were tractioned reduction before operation, and followed for 3 months by immobilization in brace after operation. Results A mean of 24 months follow-up（range： 2-72 months） was achieved in 12 patients. There were no other complications, except a malunion of odontoid process fracture in 1 patient who underwent excessive cervical movement. Improvement of neurological function was observed in all the 5 patients. Conclusion Anterior single-screw fixation of odontoid fractures is associated with a relatively low complication rate and a high fusion rate in this study, and is recommended to be the first treatment for type Ⅱ and shallow type Ⅲ odontoid fracture.