颈椎前路单枚空心螺钉置入治疗Ⅱ型齿状突骨折

Anterior cervical single hollow screw placement for the treatment of type Ⅱ odontoid fractures

背景:齿状突骨折前路加压螺钉内固定治疗后可以获得较高的愈合率,并且最大限度的保留寰枢椎间的活动功能。目的:分析颈椎前路加压螺钉内固定治疗Ⅱ型齿状突骨折的疗效以及并发症。方法:收集2002年8月至2012年12月上海交通大学医学院附属第三人民医院骨科经前路单枚空心螺钉内固定治疗的齿状突骨折患者,选取48例患者在C型臂X射线机监视下行前路单枚加压螺钉内固定治疗新鲜Ⅱ型齿状突骨折,进行回顾性分析。通过内固定治疗前后以及末次随访时的体格检查,拍摄患者上颈椎正侧位及张口位X射线片,评价并分析其治疗后疗效以及并发症情况。结果与结论:患者在颈椎前路单枚空心螺钉置入内固定治疗后进行随访,随访时间6-47个月,平均13.4个月。有7例患者发生并发症,吞咽困难3例,经3-6个月随访治愈,螺钉松动3例,经延长外固定时间后治愈,不愈合患者1例,二期行后路寰枢椎融合固定后治愈,其余患者均获得良好骨愈合,愈合后寰枢椎旋转功能无明显受限。颈前路单枚空心螺钉固定治疗Ⅱ型齿状突骨折并发症低,骨折愈合率高,功能恢复好。严格选择适应证、内固定治疗中精细操作,是避免并发症出现的关键。

BACKGROUND：Anterior compression screw fixation for the treatment of odontoid fractures can obtain a higher healing rate, and can retain the atlantoaxial intervertebral activities to the maximum extent. OBJECTIVE：To analyze the effect and complications of anterior compression screw fixation for the treatment of type Ⅱ odontoid fractures. METHODS：The odontoid fractures patients treated with anterior cervical single hol ow screw fixation were selected from Department of Orthopedics, No.3 People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between August 2002 and December 2012. Forty-eight patients received the anterior compression screw fixation under the monitor of C-arm X-ray machine for the treatment of fresh type Ⅱ odontoid fractures, and then the retrospective analysis was performed. The anteroposterior and mouth-open X-ray films of upper cervical spine were taken before and after fixation and during the final fol ow-up period to evaluate and analyze the effect after treatment as wel as the occurrence of complications. RESULTS AND CONCLUSION：The patients were fol owed-up for 6-47 months, averaged 13.4 months, after treated with anterior cervical single hol ow screw fixation. The results showed seven cases suffered from complications and three cases had dysphagia, and healed after 3-6 months fol ow-up;three cases had screw loosening, and healed after prologing the external fixation time;non-healed in one case, and then healed after posterior atlantoaxial fusion and fixation in the second stage;other cases were wel-healed, and the atlantoaxial rotation function was not limited significantly after healing. Anterior cervical single hol ow screw fixation for the treatment of type Ⅱ odontoid fractures has the advantages of lower incidence of complications, higher fracture healing rate and wel function recovery. Strict selection of indicators and precise operation are the keys to avoid complications.