枢椎泪滴样骨折治疗方法的选择及疗效分析

Treatment options and efficacy analysis of teardrop fracture of the axis

目的探讨枢椎泪滴样骨折治疗方法的选择及疗效分析。方法回顾性分析2003年3月-2013年6月收治的19例枢椎泪滴样骨折患者，分别占同期收治的颈椎损伤患者的3．9％和枢椎骨折患者的11．4％。其中男15例，女4例；年龄21-56岁，平均37．8岁。致伤原因：交通伤12例，跌落伤6例，重物砸伤1例。入院后常规行颈椎X线片、CT及MRI检查，13例接受3～6个月不等的Halo-vest支架外固定治疗，6例接受颈前路或后路手术治疗。对所有患者行影像学评价，同时行视觉模拟评分（VAS）、神经功能评价[美国脊柱损伤协会（ASIA）分级标准]，观察内固定松动断裂、骨融合等情况。结果所有患者均获得随访，时间12～18个月，平均15．6个月。末次随访时，手术患者无内固定松动、断裂等，18例枢椎泪滴样骨折实现骨愈合，1例未愈合。所有患者颈部活动度基本恢复正常，VAS由（7．5±1．2）分恢复至（3．1±1．5）分；18例ASIA分级仍为E级，1例进展为D级。结论枢椎泪滴样骨折是临床上比较少见的颈椎损伤类型，大部分患者颈椎稳定性尚可，通过非手术治疗即可获得较好的临床疗效，但当影像学上提示有不稳定性因素存在时，手术治疗往往是必要的。

Objective To determine the treatment options for teardrop fracture of the axis and discuss the treatment efficacy. Methods Nineteen patients with teardrop fracture of the axis treated from March 2003 to June 2013 were retrospectively reviewed. Teardrop fracture of the axis accounted for 3.9% of the cervical injuries and 11.4% of the axis fractures over the same period. There were 15 males and 4 females, at age range of 21-56 years （mean, 37.8 years）. Injury was caused by traffic accidents in 12 patients, falls in 6, and hit from heavy objects in 1. Cervical imaging examinations （X-ray, CT and MRI） were performed on admission. Thirteen patients were immobilized for 3 to 6 months with the Halo- vest device, and six patients underwent anterior cervical surgery. No patients had neurologic deficit [ American Spinal Injury Association （ASIA） grade E ]. Visual analogue scale （VAS）, implant failure and bone fusion were recorded after operation. Results All patients were followed up for 12-18 months （mean, 15. 6 months ）. At the final follow-up, no implant loosening or breakage happened and 18 patients achieved bone union. Neck mobility returned to normal, which showed VAS improved from （7.5 ± 1.2）points to （3.1 ± 1.5 ）points. ASIA grade E remained in 18 patients, and one patient were progressed to grade D. Conclusions Teardrop fracture of the axis is rare cervical injury, and can be treated conservatively in most cases. However, surgery is often necessary when imaging findings suggest the existence of instability.