非融合固定与齿状突螺钉固定治疗Anderson-D'AlonzoⅡ型齿状突骨折的疗效比较

Posterior atlantoaxial non-fusion fixation versus anterior cervical odontoid screw fixation in treatment of odontoid fracture of Anderson-D'Alonzo typeⅡ

目的比较颈椎后路寰枢椎非融合固定与颈椎前路齿状突螺钉固定治疗齿状突Anderson-D'AlonzoⅡ型骨折的疗效。方法回顾性分析2015年1月至2020年1月河南省漯河市中心医院脊柱科收治的21例Anderson-D'AlonzoⅡ型齿状突骨折患者资料。根据治疗方法不同分为后路组(采用后路寰枢椎非融合固定手术治疗)和前路组(采用前路齿状突螺钉固定)。后路组12例,男7例,女5例;年龄(42.2±11.8)岁。前路组9例,男5例,女4例;年龄(40.0±9.1)岁。比较两组患者的手术时间、手术出血量、术中透视次数、骨折愈合时间、颈椎总旋转度及颈椎功能障碍指数(NDI)。结果两组患者术前一般资料的比较差异均无统计学意义(P>0.05),具有可比性。两组患者均成功置入内置物,术中骨折复位满意,未发生动静脉血管及脊髓损伤。所有患者术后随访(24.5±11.3)个月。所有患者均成功置入内置物,术中骨折复位满意,未发生动静脉血管及脊髓、神经损伤。前路组患者的手术时间[(108.5±15.9)min]、术中出血量[(48.3±12.2)mL]显著少于后路组患者[(153.9±34.2)min、(275.8±56.0)mL],前路组患者的术中透视次数[(13.0±2.1)次]显著多于后路组患者[(7.2±1.4)次],差异均有统计学意义(P<0.05)。两组患者间骨折愈合时间比较差异无统计学意义(P>0.05)。末次随访时两组患者间颈椎总旋转度、NDI比较差异均无统计学意义(P>0.05)。结论后路寰枢椎非融合内固定技术能够保留颈椎旋转活动范围、降低颈椎功能障碍。前路螺钉固定手术时间短、出血少,但术中接受X线照射次数多。两种手术内固定方法个体化应用治疗齿状突Ⅱ型骨折,均可获得良好疗效。

Objective To compare the curative effects of posterior atlantoaxial non-fusion fixation and anterior cervical odontoid screw fixation in the treatment of odontoid fracture of Anderson-D'Alonzo typeⅡ.Methods A retrospective study was conducted to analyze the clinical data of 21 patients with odontoid type II fracture who had been treated at Department of Spine Surgery,The Central Hospital of Luohe from January,2015 to January,2020.The patients were divided into a posterior group subjected to posterior atlantoaxial non-fusion fixation and an anterior group subjected to anterior cervical odontoid screw fixation.In the posterior group of 12 patients,there were 7 males and 5 females with an age of(42.2±11.8)years.In the anterior group of 9 patients,there were 5 males and 4 females with an age of(40.0±9.1)years.The 2 groups were compared in terms of operation time,bleeding volume,intraoperative fluoroscopy,fusion time,cervical rotation and neck dysfunction index(NDI).Results The differences in the preoperative general information were not statistically significant between the 2 groups,indicating comparability(P>0.05).The implants were successfully inserted in all patients.Intraoperative fracture reduction was satisfactory and no arteriovenous or spinal cord injuries occurred.The mean follow-up time was(24.5±11.3)months.The operation time[(108.5±15.9)min]and bleeding volume[(48.3±12.2)mL]in the anterior group were significantly less than those in the posterior group[(153.9±34.2)min and(275.8±56.0)mL],and the intraoperative fluoroscopy[(13.0±2.1)times]in the anterior group was significantly higher than that in the posterior group[(7.2±1.4)times](P<0.05).There was no statistically significant difference in fracture healing time between the 2 groups(P>0.05).There was no statistically significant difference either in total cervical rotation or NDI between the 2 groups at the last follow-up(P>0.05).Conclusions Posterior atlantoaxial non-fusion fixation can preserve the range of rotation of the cervical spine and reduce the dysfunction of the cervical spine.The anterior screw fixation may result in shorter operation time and less intraoperative bleeding,but more intraoperative X-ray fluoroscopy.Therefore,the 2 internal fixation methods should be adopted on the basis of each individual in the treatment of odontoid typeⅡfracture to achieve good curative results.