成人齿状突骨折的治疗策略

Strategy of treatment for odontoid fractures in adults

对于齿状突骨折的治疗目前无一致意见,且尚无充分证据支持骨折的非手术或手术治疗选择。影响骨折愈合的因素包括骨折平面、是否移位和移位程度以及患者的年龄,笔者建议的手术适应证包括明显移位或成角、年龄>50岁、ⅡA型骨折、非手术治疗不能维持骨折稳定和陈旧性骨折。手术治疗应尽量选择前路螺钉内固定而避免融合。

There is a lack of general consensus on the treatment of odontoid fractures in adults,and sufficient evidence to support treatment standards has not been found yet. Fracture healing may be related with the level and displacement of fracture,and the age of patients. Surgical treatment is recommended for Type Ⅱ and Ⅲ fractures in case of significant displacement or angulation, 50 years and older, comminution （ Type Ⅱ A ） , inability to maintain fracture stability with conservative means and remote fractures. For surgical treatment, anterior screw fixation should be considered before arthrodesis.