Gallie植骨联合钛缆固定与Harms C1，2侧块／椎弓根螺钉固定植骨融合治疗齿状突骨折的比较

Treatment of odontoid fractures with Gallie technique with titanium cable fixation and Harms C1,2 screw fixation： a comparative study

目的比较Gallie植骨联合钛缆固定与Harms C1，2侧块／椎弓根螺钉固定植骨融合治疗齿状突骨折的临床疗效。方法选择2003年7月-2008年7月手术治疗Ⅱ、Ⅲ型齿状突骨折26例，其中男18例，女8例；年龄22～65岁，平均43岁。按手术方法分组：寰枢椎钛缆固定植骨融合术（Gallie钛缆组，14例），Harms C1，2侧块／椎弓根螺钉内固定术（Harms螺钉组，12例）。分别比较两组患者术中出血量、手术时间、治疗费用、住院时间、植骨融合时间、并发症、二次手术率等指标，并进行统计学分析。结果本组末次随访时间18～84个月，平均37．3个月，Gallie钛缆组术中出血量、治疗费用少于Harms螺钉组（P〈0．05），重返工作时间长于Harms螺钉组（P〈0．05）。两组手术时间、住院时间差异无统计学意义（P〉0．05）。Harms螺钉组骨融合时间短于Gallie钛缆组，但差异无统计学意义（P〉0．05）。Gallie钛缆组1例植骨不融合，2例延迟愈合，1例钛缆断裂，再次手术取出钛缆。Harms螺钉组1例因伤口感染再次行清创手术，1例植骨延迟愈合。结论Gallie钛缆组与Harms椎弓根螺钉固定组患者均有下地时间早、住院周期短的优点。尽管经椎弓根螺钉固定患者花费较大，但患者可以早丑康复。

Objective To compare the clinical outcome of posterior Gallie method with cable fixation and Harms technique with C1,2 pedicle screw fixation in treatment of odontoid fractures. Methods From July 2003 to July 2008, 26 patients with types Ⅱ and Ⅲ odontoid fractures were treated surgically. There were 18 males and 8 femalses, at age range of 22-65 years （ average 43 years）. The patients were divided into Gallie titanium cable fixation group （Gallie group, n = 14） and C1-C2 posterior screw fixation group using Harms technique （Harms group, n = 12） according to treatment methods to compare blood loss, operation duration, costs, hospital stay, bone fusion time, complications and secondary operation. Results The patients were followed up for 18-84 months （ average 37.3 months）. The average blood loss and costs in Gallie group were significantly less than that in Harms group （ P 〈 0.05 ）, while the time for back to work in Gallie group was significantly longer than that in Harms group （ P 〈 0.05 ）. There was no statistical difference upon operation duration, hospital stay and bone fusion time in two groups （P 〉 0.05 ）. There was one patient with nonunion and two with delayed union in Gallie group and one with secondary operation due to implant failure in Gallie group, and one with secondary debridement due to wound infection and one with delayed wound healing in Harms group, with no statistical difference （P 〉 0.05）. Conclusions Both Gallie technique with titanium cable fixation and Harms C1,2 screw fixation have advantages of early walk and short hospital stay. Compared with the former, the latter technique costs more but can help early back to work.