Halo—vest支架辅助下三期手术治疗特殊Anderson—D’AlonzoⅡ型、浅Ⅲ型枢椎齿状突骨折

Three-phase surgical treatment assisted with Halo-vest for special Anderson-D＇Alonzo type II and superficial type HI odontoid fractures

目的探讨Halo—vest支架辅助下三期手术治疗特殊Anderson—D’AlonzoII型、浅Ⅲ型枢椎齿状突骨折的临床疗效。方法采用回顾性病例系列研究分析2007年1月-2015年1月收治的15例骨折间隙〉2mm、齿状突移位〉5mm、骨折断端成角〉11。的特殊Anderson～D’AlonzoII型、浅Ⅲ型枢椎齿状突骨折患者临床资料，其中男9例，女6例；年龄27—61岁[（44．5±10．9）岁]。在Halo—vest支架外固定、自发研制的齿状突导针瞄准器等配合下，分三期进行治疗。I期：颈椎牵引复位后，行Halo—vest支架外固定术；1I期：Halo—vest支架外固定下，行齿状突导针瞄准器定位引导下颈椎前路空心拉力螺钉内固定术；m期：拆除Halo—vest支架，改行颈托外固定。记录手术时间、术中出血量、并发症情况及手术前后视觉模拟评分（VAS）情况。定期复查颈椎侧位及张口位x线片和（或）寰枢椎CT平扫＋矢状面及冠状面二维重建，评价螺钉位置、复位及骨折愈合情况等。结果患者均获随访12—36个月，平均28个月。手术时间54～96min[（71．3±11．9）min]。术中出血量5～60ml[（32．6±16．8）m1]。无脊髓或神经根损伤、脑脊液漏、切口感染等并发症发生。14例术后6个月可见骨性连接形成，1例出现假关节。末次随访时，1例假关节患者骨折断端骨质硬化，其余患者骨愈合良好。术前VAS为（7．3±0．6）分，术后1个月VAS为（1．6±0．7）分（P〈0．05）。结论Halo—vest支架外固定辅助下三期手术治疗Anderson—D’AlonzoII型、浅Ⅲ型枢椎齿状突骨折，术前可提供良好的稳定性，术后可促进骨折愈合及疼痛缓解，值得临床推广。

Objective To assess the efficacy of internal fixation assisted with Halo-vest in the treatment of Anderson-D＇Alonzo type II and superficial type III odontoid fractures. Methods A retrospective case series study was made on 15 patients clinically diagnosed as Anderson-D＇Alonzo type II and type III odontoid fractures with a fracture gap over 2 mm, displacement over 5 mm and broken end angel over 11° from January 2007 to January 2015. There were nine males and six females, aged 27-61 years [ （44.5 ± 10.9 ） years ]. The patients were treated in ＂three phases＂ with the assistance of Halo-vest external fixation system and a novel guide pin aiming device. The three phases were as follows： phase I： cervical traction reduction and halo-vest external fixation; phase II： Halo-vest assisted internal fixationusing the novel aiming device; phase III： the Halo-vest fixation removal and cervical collar fixation. Operation duration, intraoperative bleeding, and postoperative visual analogue scale （VAS） pain score one month after the operation were recorded. The cervical lateral and open mouth X-ray or atlantoaxial CT scan with sagittal and coronal two-dimensional reconstruction were regularly reviewed, and the location of screws, reduction and fracture healing were evaluated. Results Operation duration ranged from 54 to 96 minutes [ （71.3 ＋ 11.9） mini. The intraoperative blood loss was 5-60 ml [ （32.6 ± 16.8） ml]. There was no spinal cord or nerve root injury, cerebrospinal fluid leakage, wound infection or other complications. All patients were followed up for 12-36 months （mean, 28 months）. Fourteen patients were seen bony union 6 months after the surgery and one patient was seen a false joint. At the last follow-up, the patient with false joint was seen bone sclerosis, and other patients with sound bone healing. The preoperative VAS and that of one month after the operation was （7.3 ± 0.6 ） points and （ 1.6 ± 0.7 ） points, respectively （P 〈 0.05）. Conclusion For Anderson-D＇Alonzo type II and type III odontoid fractures, which have a fracture gap greater than 2 mm, displacement more than 5 mm, broken end angle above 11 degrees, the three-phase Halo-vest assisted internal fixation can provide good stability before operation and promote bone healing and pain relief after operation.