老年Ⅱ型齿状突骨折的治疗

Management of type Ⅱ odontoid fractures in the aging people

目的:探讨老年Ⅱ型齿状突骨折的治疗方法。方法:1997年1月～2006年8月共收治33例老年Ⅱ型齿状突骨折患者,男13例,女20例,年龄65～89岁,平均78岁。12例采用保守治疗(牵引、颈围、头颈胸石膏固定),9例采取前路单枚螺钉固定,12例采用后路C1-C2融合技术。评价保守治疗、前路手术、后路手术的治疗效果。结果:手术期间无患者死亡,随访11～47个月,平均26个月,保守治疗7例不愈合,前路螺钉固定3例不愈合,后路融合2例不愈合。12例患者随访期间死于其他疾病。结论:对于老年Ⅱ型齿状突骨折应优先考虑手术治疗,对于采用前路手术还是后路手术,需结合患者齿状突具体形态、骨折类型来决定,单纯前路单枚螺钉固定效果并不可靠。

Objective：To investigate the optimal treatment for type Ⅱ odontoid fractures of aging patients. Method：33 patients older than 65 years with Type Ⅱ odontoid fractures （13 men,20 women,mean age 78, range 65-89 years） were analyzed retrospectively.9 patients were treated with anterior screw fixation according to Bohler,12 with a posterior C1-C2 fusion.12 patients were treated conservatively.Result：There were no peroporative deaths.The mean follow-up was 26 months （11-47 months）,10/12 patients with posterior fusion had healed without any problems,whereas 3/9 patients treated with anterior screw fixation,and 7/12 conservatively treated patients were failures with union.Ten patients died from unrelated causes during the follow-up period.Conclusion：Conservative treatment is associated with an unacceptably high rate of problems in the elderly patients and primary stabilization with internal fixation is recommended.The operative approach can be chosen according to the fracture types and morphology of odontoid process.One screw appears to be insufficient to provide enough stability at the fracture site.