后路椎弓根螺钉非融合内固定术治疗新鲜Ⅱ型齿状突骨折

Posterior pedicle screw fixation without fusion for fresh type II odontoid fracture

[目的]评估C1/2后路椎弓根螺钉骨折复位非融合内固定术对新鲜Ⅱ型齿状突骨折的疗效。[方法]回顾性分析2015年6月~2017年6月颈后路寰枢椎椎弓根螺钉复位固定非融合术+Ⅱ期去除内固定术治疗的齿状突骨折患者62例,其中男性39例,女性23例,年龄17~78岁。采用疼痛视觉模拟评分(VAS)、颈椎日本骨科协会评分(JOA)和影像检查评估临床疗效。[结果]本组62例患者均顺利完成手术,术中无脊髓、神经根和椎动脉损伤。手术时间75~160 min,平均(95.32±18.46)min;出血量90~400 ml,平均(150.47±50.92)ml。术后脑脊液漏2例,其中1例保守治疗后愈合,另1保守治疗失败后行二次手术修复硬膜治愈。切口浅表感染3例,经非手术治疗痊愈。随访时间24~36个月,平均(26.46±1.32)个月。术后12个月取出内固定物。末次随访时,VAS评分由术前(7.62±0.91)分降低至(2.91±1.23)分,差异有统计学意义(P<0.05);JOA评分由术前(7.21±2.11)分上升至末次随访时(13.22±2.41)分,差异有统计学意义(P<0.05)。所有患者C1/2活动度得到保留。影像方面:术中所有患者C型臂X线机透视下显示寰枢椎完全复位,术后12个月所有患者骨折均达到骨性愈合,无内固定松动、移位;末次随访时,所有患者内固定物已取出,齿状突愈合良好,无畸形,C1/2间隙正常。[结论]后路寰枢椎椎弓根螺钉复位固定非融合术+Ⅱ期去除内固定术治疗新鲜Ⅱ型齿状突骨折可保留C1/2活动度,并取得满意的临床效果。

[Objective] To evaluate the clinical outcomes of posterior pedicle screw fixation without fusion for fresh type Ⅱ odontoid fracture. [Methods] A retrospective study was conducted on 62 patients who underwent posterior pedicle screw fixation without fusion for fresh type Ⅱ odontoid fracture in our hospital from June 2015 to June 2017. The patients included 39 males and 23 females, aged 1778 years. The visual analogue scale(VAS) for pain, Japanese Orthopaedic Association(JOA)score for cervical spine and imaging examination were used for evaluation of the consequences. [Results] All the 62 patients had surgical procedures performed smoothly without iatrogenic injuries to the spinal cord, nerve root and vertebral artery during operation. The operation lasted for 75160 min with a mean of(95.32±18.46) min, associated with intraoperative blood loss of 90400 ml with a mean of(150.47±50.92) ml. Two patients got spinal fluid leakage after operation, one of them was cured by corresponding conservative therapy, while another recovered after dural repairing in the revision surgery due to failure to conservative therapy. Three patients suffered from incision superficial infection, which subsided following dressing change and antibiotic therapy. The follow-up period ranged from 24 to 36 month with a mean of(26.46±1.32) months. All the patients had the internal implants removed about 12 months after the primary operation based on bony healing of odontoid fracture. The VAS score significantly decreased from(7.62±0.91) preoperatively to(2.91±1.23) at the latest follow up(P<0.05), whereas the JOA score significantly increased from(7.21±2.11) preoperatively to(13.22±2.41) at the last interview(P<0.05). All patients preserved mobility between the C1 and the C2 at the latest follow up. Regarding to imaging assessment, all the patients achieved complete reduction of the odontoid fracture during the primary operation, and bony healing of the fracture in 12 months after operation without loosening or displacement of the implants. To the latest follow up, all of them had implants removed, and got solid bony healing of the odontoid without deformities, whereas preserved normal space between C1 and C2.[Conclusion] This posterior pedicle screw fixation combined implant removement in second stage does preserve the mobility of upper cervical spine with sound clinical outcomes.