枢椎齿状突骨折的治疗术式选择

A CHOICE OF PROCEDURE FOR FRACTURES OF THE ODONTOID PROCESS

目的探讨枢椎齿状突骨折的治疗方法及效果。方法回顾性研究19例枢椎齿状突骨折病人,分别采用Halo-vest外固定术、前路空心螺钉固定术、后路经关节突侧块螺钉加钢丝固定术、后路钢丝固定术、寰枢融合术。采用JOA评分标准评定神经功能恢复情况,影像学检查评定植骨融合情况。结果19例病人经术后5～30月的随访,所有病人骨折均已愈合或植骨融合,无脊髓神经损伤加重现象,所有内固定均未出现松动、断裂及脱出现象。结论齿状突骨折术式的选择取决于病人的实际情况,包括年龄、骨折类型、骨折成角、骨折移位等情况,以及术者的临床经验。

Objective To evaluate the methods and efficacy of therapy for fractures of odontoid process. Methods A retrospective review of 19 cases with odontoid fractures was done. The procedures perfomed for the cases included Halo-vest, Magerl ＋Gallie, Gallie, or atlantoaxial fusion. Functional recovery of the nerve was assessed by JOA score and fusion of the bone graft by imageology. Results Postoperative follow up for five to 30 months showed the fractures were healed or bone graft fusioned in all the 19 cases. No aggravation of spinal nerve damage was recorded. No loosened, broken or prolapsed internal fixation was found. Conclusion The option of surgical procedures for fracture of odontoid process mainly depends on the patient＇s age, classification, angulation and displacement of the fracture as well as the experience of the surgeon.