不同类型齿状突骨折的外科治疗策略

Clinical analysis of surgical treatment of odontoid fracture

目的探讨不同类型齿状突骨折的相应治疗方法及临床效果。方法对21例齿状突骨折患者根据Anderson—D’Alonzo分型进行不同方法治疗：Ⅰ型骨折3例枕颌带牵引＋6周后头颈胸石膏固定；Ⅱ型骨折13例行颅骨牵引复位后齿状突中孔螺钉固定；DI型骨折5例，颅骨牵引复位后1例行齿状突中空螺钉固定，4例行颈后路寰枢椎椎弓根螺钉固定。结果随访6～48个月，平均9个月，骨折均获骨性愈合，未出现术后并发症。结论齿状突骨折应按类型区别处理，Ⅰ型骨折、深Ⅲ型骨折应当采用保守疗法，Ⅱ型及浅Ⅲ型骨折使用齿状突中空螺钉固定术治疗可获得满意效果，对于不适合齿状突中空螺钉治疗的浅Ⅲ型骨折，可选用颈后路寰枢椎椎弓根螺钉固定术。

Objective To evaluate the therapies and clinical outcome for different types of odontoid process fracture. Methods Twenty-one patients with odontoid process fracture were treated with different therapies for different Anderson-D＇Alonzo classifications： three cases of type Ⅰ were treated by traction of occipital-jaw band and fixed with head-neck-chest plaster at 6 weeks ; thirteen cases of typeⅡ were treated by cannulated screws following skull traction and reduction; and for the cases of type Ⅲ, one was fixed with screw when the fracture was reduced by skull traction, and four with atlantoaxial pediele screw. Results All cases were followed up for a mean of 9 months （range： 3-48 ）. All cases achieved bony union. No postoperative complication was found. Conclusion Odontoid process fracture should be treated according to different types. Conservative treatment for type Ⅰ fracture and eannulated screws for type Ⅱand low type Ⅲ fracture can obtain a satisfactory outcome. Atlantoaxial pedicle screw should be chosen if the superficial type Ⅲ fracture is not suitable for cannulated screw.