新鲜Ⅱ型齿状突骨折的术式选择及治疗效果

Clinical results and surgical options of fresh type Ⅱ odontoid fracture

目的：总结应用不同术式治疗Ⅱ型新鲜齿状突骨折的效果,探讨其术式选择。方法：2002年6月2010年6月,在我院手术治疗并获得随访的Ⅱ型新鲜齿状突骨折患者84例,男56例,女28例,年龄2168岁。术前均伴有颈项部疼痛和活动受限,17例合并不程度寰枢水平的颈脊髓损伤症状。19例为单纯齿状突骨折,65例合并寰枢椎脱位。入院后均行颅骨牵引,骨折均有不同程度的复位。根据骨折线类型、伴随损伤和骨质情况,58例采用前路单枚中空螺钉固定（A组）,26例采用后路寰枢椎椎弓根钉棒系统固定融合（B组）。结果：术中均未发生椎动脉和脊髓损伤。所有患者均获随访,随访时间3～24个月,平均8个月,A组58例患者54例获得骨性愈合,4例纤维性愈合,颈椎屈伸和旋转功能正常;B组均获得骨性愈合,颈椎旋转功能不同程度受限。结论：Ⅱ型新鲜齿状突骨折应根据齿状突的骨折线类型及患者个体情况选择相应的手术方法,单枚中空螺钉固定可保留颈椎的正常活动功能。

Objective：To summarize the clinical results of anterior cannulated odontoid screw fixation and posterior C1-C2 screw-rods fixation for fresh type Ⅱ odontoid fracture.Method：From June 2002 to June 2010,84 cases with fresh type Ⅱ odontoid fracture treated surgically in our hospital were reviewed retrospectively.Among them,there were 56 males and 28 females,aged from 21 to 68 years old.All patients complained of neck pain and limited cervical ROM,and 17 cases presented with cervical spinal cord deficit.65 cases were complicated with atlantoaxial dislocation.After admission,all patients underwent skull traction and showed some degrees of atlantoaxial reduction.According to the fracture types and individual status,58 patients underwent cannulated odontoid screw fixation（group A）,while 26 patients experienced C1-C2 screw-rods fixation（group B）.Result：No intraoperative vertebral artery injury and spinal cord injury were noted.All 84 patients were followed up for an average of 8 months（range,3-24 months）.54 of the 58 patients in group A got bony union,and 4 cases obtained fibrous healing.Cervical movement of patients in group A recovered to normal.All patients in group B got bony union,with some degree of limitation of the rotation.Conclusion：The management of fresh type Ⅱ odontoid fracture should be performed individually.Unicannulated odontoid screw fixation can maintain normal movement of cervical spine.