Ⅱ型齿状突骨折的影像学测量与直接中空螺钉内固定

Radiographic Measurement and Direct Hollow Screw Internal Fixation for Type Ⅱ Odontoid Process Fracture

目的 研究正常国人齿状突及Ⅱ型齿状突骨折的基本影像数据 ,指导Ⅱ型齿状突骨折的内固定。探讨颈前路直接中空螺钉内固定治疗Ⅱ型齿状骨折的价值及作用。方法 正常成人齿状突螺旋CT影像资料 2 6份 ,Ⅱ型齿状突骨折影像资料 1 4份 ,在计算机上采用螺旋CT的影像标尺直接测量枢椎的总高度、齿状突长度、Ⅱ型骨折骨折线距齿状突尖的距离进针的后倾角及枢椎可供中空螺钉固定长度。同时采用中空螺钉直接固定治疗Ⅱ型齿状突骨折 1 4例。结果 枢椎高度为 37 2 6± 2 4 2mm ,齿状突长度 1 3 80± 1 32mm、齿状突基底的冠状径为 8 6 3± 1 1 2mm ,矢状径为 1 0 2 8± 1 0 3mm ,骨折线距齿状突尖的距离为1 1 80± 2 1 2mm ,进针后倾角 1 6 78± 3 4 8°。临床应用 1 4例 ,经平均 1 6 7个月随访骨折愈合时间平均 3 6个月 ,术后颈椎活动度为旋转 96 2°± 1 8 2°,屈伸 4 0 2°± 1 6 3°,无并发症发生。结论 国人Ⅱ型齿状突骨折内固定的螺钉长为 4 0cm ,直径4 5mm ,远端螺纹长为 1cm较合适。直接中空螺钉内固定能使齿状突骨折端加压 ,骨折愈合率高 ,但不影响颈椎的活动 。

Objective To research normal Chinese basic radiographic datas of odontoid process and type Ⅱ odontoid process fracture,giving the guidence to the internal fixation of type Ⅱ odontoid process fracture,and to discuss the value and effect of type Ⅱ odontoid process fracture treated with cervical anterior approach operation and direct hollow screw internal fixation.Methods Twenty six normal Chinese adult spiral CT datas of odontoid process,14 type Ⅱ odontoid process fracture datas,the total height of the axis,the hength of odontoid process,the distance from fracture line to the cusp of odontoid process in type Ⅱ odontoid process fracture,the posterior incline angle of screw and the length that can be used to fixated with screw of the axis were measured with the radiographic scale of the spinal CT in computer,14 patients with type Ⅱ odontoid process fracture were treated with direct hollow screw internal fixation.Results The total height of the axis was 37 26±2 42 mm,the length of odontoid process was 13 80±1 32 mm,the coronal diameter of the fundus of odontoid process was 8 63±1 12 mm,sagittal diameter was 10 28±1 03 mm,the distance from fracture line to the cusp of odontoid process was 11 80±2 12 mm,the posterior incline angle of screw was 16 78°±3 48°.The 14 patients were followed up mean 16 7 months and all the fracture union in mean 3 6 months,the postoperative cervical vertebra motion range was that:rotation degree was 96 2°±18 2°,flexion/extension 40 2°±16 3°,without any complication.Conclusion The screw length 4 0 cm and the diameter 3 5 mm,the distal screw thread length 1 cm to Chinese peoples internal fixation of type Ⅱ odontoid process fracture is appropriate.Direct hollow screw internal fixation can give compression to the odontoid process fracture,with high fracture union rate and without influence on the motion range of cervical vertebra,is a ideal therapy.