经皮前路螺钉固定治疗枢椎齿状突骨折

Percutaneous anterior screw fixation in the treatment of odontoid fractures

目的回顾性分析经皮和开放前路螺钉固定治疗枢椎齿状突骨折，比较两种方法的临床和影像学结果。方法2003年3月至2010年5月，115例齿状突骨折患者接受前路螺钉固定治疗并获得随访。年龄16-71岁，平均43．5岁。经皮固定组47例：Ⅱ型骨折42例，浅Ⅲ型骨折5例；采用经皮工作通道下前路螺钉固定。开放固定组68例：Ⅱ型骨折61例，浅Ⅲ型7例；采用传统开放手术方法治疗。分析两组手术时间、术中出血量、术者放射线暴露时间、骨折愈合和并发症等方面的差异。结果115例患者均获得随访，随访时间12-70个月，平均37．6个月。术前两组性别、年龄、骨折类型、受伤至手术时间、伴发脊柱损伤情况差异无统计学意义。平均手术时间：经皮固定组（40．3±9．5）min，开放固定组（62．9±15．3）min，经皮固定组显著短于开放组（P〈0．05）。术中平均出血量：经皮固定组（5．6±4．1）ml，开放固定组（47．1±28．6）ml，经皮固定组显著少于开放组（P〈0．01）。两组在术者放射线暴露时间、骨折愈合情况和并发症发生率方面差异无统计学意义。结论经皮前路螺钉固定是一种安全有效的治疗Ⅱ型或浅Ⅲ型齿状突骨折的方法，与开放固定法比较创伤相对小。

Objective To retrospectively analyze the treatment of odontoid fractures using percuta- neous and open anterior screw fixation, and compare the clinical and radiographic results of the two tech- niques. Methods From March 2003 to May 2010, 115 patients with odontoid fracture were treated with an- terior screw fixation, and all patients were followed up. The mean age of the patients was 43.5 years （range, 16-71）. Forty-seven patients who underwent percutaneous anterior screw fixation were set as the pereuta- neous fixation group, including 42 cases of type Ⅱ odontoid fracture and 5 of rostral type Ⅲ fracture. Sixty- eight patients who received open anterior screw fixation were set as the open fixation group, composing of 61 cases of type Ⅱ odontoid fracture and 7 of rostral type Ⅲ fracture. We compared the operative time, intraoperative blood loss, X-ray exposure time, fracture union and complications between the two groups. Results The average follow-up duration was 37.6 months with a range of 12-70 months. The gender, age, classification of odontoid fractures, time after the injuries and concomitant spinal injuries showed a similar pattern in both groups. The operating time and intra-operative blood loss in percutaneous fixation group were （40.3±9.5） min and （5.6±4.1） ml respectively, and in open fixation group were （62.9±15.3） rain and （47.1±28.6） ml respectively, both of them were significantly superior in percutaneous fixation group than in open fixation group （P〈0.05）. There was no statistical difference in radiation exposure time, fracture union and incidence of complication between the two groups. Conclusion Comparing with open screw fixation, pereutaneous anterior screw fixation is a safe and reliable procedure for treatment of type II and rostral type III odontoid fractures with potential advantages.