经皮前路齿状突和关节突螺钉固定治疗老年Ⅱ型齿状突骨折疗效观察

PERCUTANEOUS ANTERIOR ODONTOID AND TRANSARTICULAR SCREW FIXATION FOR TYPE Ⅱ ODONTOID FRACTURES IN ELDERLY PATIENTS

目的探讨经皮前路齿状突和关节突螺钉固定治疗老年Ⅱ型齿状突骨折的疗效。方法 2009年10月-2012年3月,对5例老年齿状突骨折患者行经皮前路3枚螺钉固定齿状突和双侧寰枢椎关节突治疗。男4例,女1例;年龄65～74岁,平均69.4岁。均为高处坠落致伤。受伤至手术时间3～12 d,平均6.8 d。齿状突骨折根据AndersonD’Alonzo分型方法,均为Ⅱ型;伴寰椎前弓骨折1例。神经功能按Frankel分级,E级4例,D级1例。记录手术时间、术中出血量、放射线暴露时间和并发症情况,摄X线片观察寰枢椎稳定和内植物情况。结果患者均顺利完成手术,无转为开放手术者。手术时间93～114 min,平均103.6 min;术中出血量3～10 mL,平均5.6 mL;放射线暴露时间17～32 s,平均24.2 s。5例均获得良好寰枢椎复位。术后切口均Ⅰ期愈合。5例均获随访,随访时间12～35个月,平均21.4个月。3例术后出现吞咽困难,经对症处理5 d内症状消失。无血管、脊髓神经、气管、食道损伤及内植物失败等并发症发生。复查颈椎X线片示齿状突骨折均愈合,愈合时间5～10个月,平均7个月;螺钉位置良好、寰枢椎稳定。末次随访时5例神经功能正常,Frankel分级均为E级。3例诉颈部不适,活动受限,但不影响日常生活,未作特殊处理;余2例无不适表现。结论经皮前路螺钉固定齿状突和双侧关节突安全、有效、微创,可作为老年Ⅱ型齿状突骨折手术方法之一。

Objective To retrospectively analyze the effectiveness of percutaneous anterior odontoid and transarticular screw fixation for type II odontoid fracture treated in the elderly patients. Methods Between October 2009 and March 2012, 5 patients with odontoid fracture were treated with anterior triple screws fixation. There were 4 males and 1 female with an average age of 69.4 years （range, 65-74 years）. Fracture was caused by falling injury from height in all cases. The average time between injury and operation was 6.8 days （range, 3-12 days）. According to Anderson-D＇Alonzo classification system, all 5 cases were classified as type II odontoid fractures; 1 case accompanied by anterior arch fracture. Four cases were rated as grade E and 1 case as grade D on the basis of Frankel classification system on nerve function evaluation. Percutaneous anterior odontoid and transarticular screw fixation were used in all cases. The operation time, intra-operative blood loss, X-ray exposure time, and complications were recorded. The X-ray films were taken to observe atlantoaxial stability and implant conditions. Results All patients were successfully complete the surgery, and no open operation was needed. The average operation time was 103.6 minutes （range, 93-114 minutes）. The average intra-operative blood loss was 5.6 mL （range, 3-10 mL）. The average X-ray exposure time was 24.2 seconds （range, 17-32 seconds）. Good reduction of atlantoaxial joint and primary healing of incision were obtained in 5 patients. The average follow-up duration was 21.4 months （range, 12-35 months）. Transient dysphagia occurred in 3 cases, and was cured after 5 days of expectant treatment. No major complications of carotid artery laceration, spinal cord injury, esophageal perforation, airway obstruction, and implant failure occurred. The X-ray films showed odontoid bony union, atlantoaxial stability and good position of screws. The average time ofodontoid fracture union was 7 months （range, 5-10 months）. Five patients had normal neurological function （Frankel grade E） at last follow-up. Three patients complained of neck discomfort and movement limitation and had normal daily activities without special therapy; the other 2 patients had no clinical symptom of discomfort. Conclusion Percutaneous anterior odontoid and transarticular screw fixation is a safe and effective procedure for treatment of type II odontoid fractures in the elderly patients with minimally invasive surgical advantages.