全身麻醉后手法复位联合椎弓根螺钉内固定植骨融合术治疗Anderson Ⅱ型齿突骨折伴寰枢关节旋转性脱位交锁

Manual reduction after general anesthesia combined with pedicle screw fixation and bone graft fusion for treatment of Anderson type Ⅱ odontoid fracture and atlantoaxial joint rotation dislocation with locked-facet

目的 探讨采用全身麻醉后手法复位联合后路寰枢椎椎弓根螺钉内固定植骨融合术治疗伴寰枢关节旋转性脱位交锁的AndersonⅡ型齿突骨折的临床疗效。方法 收集2006年2月—2015年12月收治的13例合并寰枢关节旋转性脱位交锁的AndersonⅡ型齿突骨折患者的临床资料。术前交锁侧颈部旋转活动度为8°±2°,对侧为27°±9°,疼痛视觉模拟量表(VAS)评分为(5.7±1.8)分,美国脊髓损伤协会(ASIA)分级均为E级。患者均接受气管插管全身麻醉后手法复位联合后路寰枢椎椎弓根螺钉内固定植骨融合术治疗。记录手术时间、术中出血量,随访术后有无内固定松动、断裂等并发症发生及植骨融合情况。对所有患者进行影像学评估,比较术前、末次随访时颈椎旋转活动度、VAS评分和ASIA分级。结果 所有患者随访24~28个月,平均25.3个月;手术时间为80~120min,平均105min;术中出血量为100~330mL,平均150mL。末次随访时交锁侧颈部旋转活动度为45°±12°,对侧为56°±10°,两侧活动度与术前相比差异均有统计学意义(P<0.05);术后颈部疼痛症状均获得不同程度改善,VAS评分恢复至(2.2±1.3)分,与术前相比差异有统计学意义(P<0.05);末次随访时ASIA分级仍为E级。所有患者均未出现切口疼痛、感染、不愈合及神经损伤等并发症,末次随访时无内固定松动、断裂等并发症发生,均实现骨性融合,融合时间为2~4个月,平均3.1个月。1例患者复查颈椎CT时发现2枚螺钉位置欠佳,因其无不适而未予处理。结论 全身麻醉后手法复位联合后路寰枢椎椎弓根螺钉内固定植骨融合术治疗伴寰枢关节旋转性脱位交锁的AndersonⅡ型齿突骨折,可使寰枢关节复位,重建寰枢椎稳定。该术式安全、有效,能减轻患者疼痛,较大程度恢复患者颈椎功能。

Objective To explore the clinical efficacy of manual reduction after general anesthesia combined posterior atlantoaxial pedicle screw fixation with bone graft fusion for the treatment of Anderson typeⅡodontoid fracture and atlantoaxial joint rotation dislocation with locked-facet.Methods From December 2015 to February 2006,the clinical data of 13 patients with Anderson typeⅡodontoid fracture and atlantoaxial joint rotation dislocation with locked-facet were collected.Preoperative cervical rotation range of motion on the locking side was 8°±2°,while the contralateral side was 27°±9°.Preoperative visual analogue scale(VAS)score was 5.7±1.8,and the American Spinal Injury Association(ASIA)classification was grade E.All the patients underwent manual reduction after general anesthesia with tracheal intubation combined with posterior atlantoaxial pedicle screw fixation and bone graft fusion.The operative time and intraoperative blood loss,the complications such as loosening and breakage of internal fixation and bone graft fusion were recorded.All the patients were evaluated by imaging data,and cervical rotation range of motion,VAS score and ASIA classification were compared between preoperative and the final follow-up.Results All the patients were followed up for 24-28(mean 25.3)months.The operative time was 80-120(mean 105)min,and the intraoperative blood loss was 100-330(mean 150)mL.At the final follow-up,the cervical rotation range of motion on the locking side was 45°±12°,and was 56°±10°on the contralateral side;which all were better than those before operation,and the differences were statistically significant(P<0.05).Postoperative cervical pain symptoms were improved.VAS score was restored to(2.2±1.3),and the difference was statistically significant compared with that before operation(P<0.05).At the final follow-up,ASIA classification was still grade E.No complications such as incision pain,infection,nonunion and nerve injury occurred in all the patients.At the final follow-up,no complications such as loosening and breakage of internal fixation occurred.Bone fusion was achieved in all the patients,and the fusion time was 2-4(mean 3.1)months.One patient received reexamination by cervical CT and found that 2 screws were not in good position and were not treated because of no discomfort.Conclusion Manual reduction after general anesthesia combined with posterior atlantoaxial vertebral pedicle screw fixation and bone graft fusion for the treatment of Anderson typeⅡodontoid fracture and atlantoaxial joint rotation dislocation with locked-facet can make the atlantoaxial joint restoration,reconstruction of atlantoaxial vertebral stability.The operation is safe and effective,can relieve pain and restore cervical function to a greater degree.