齿状突骨折的治疗

Treatment of odontoid fracture

目的探讨各种方法治疗齿状突骨折的临床效果。方法对25例齿状突骨折行外固定、前路螺丝钉齿状突内固定和后路寰枢椎融合方法治疗。结果术后随访5个月～3.5年,平均11个月,8例行外固定和前路螺丝钉齿状突内固定,除1例外固定治疗未愈合外,均达到了骨性愈合;17例行后路寰枢椎融合,均达到了寰枢椎稳定的手术目的,颈椎前屈后伸动力X线未显出不稳定的迹象,但有8例未见明显的齿状突骨折愈合,仍有明确的骨折线。临床症状完全缓解的20例,4例残留颈项部疼痛,1例仍有上肢麻木无力。结论齿状骨折应根据其分型、移位方向、是否陈旧性骨折和术前复位情况等因素决定治疗方法。

Objective To evaluate the clinical results of different trea tments of the odontoid fracture. Methods The clinical and radiographic records o f 25 patients (19 males and 6 females, with a mean age of 35 years) who underwen t anterior screw fixation, posterior atlantoaxial arthrodesis and immobilization for odontoid fracture were reviewed retrospectively. Results A mean follow-up of 11months (5 months to 3.5 years) showed that satisfactory atlantoaxial stabil ization was achieved in all the 25 patients. X-ray films demonstrated complete fusion of the fracture in the cases who underwent anterior screw fixation and im mobilization except in 1 case who underwent only external immobilization, but no nunion of the fracture in 8 cases who underwent posterior atlantoaxial arthrodes is. Completely recovery was observed in 20 patients, except in 5 patients who st ill felt neck pain and the numbness of limb. Conclusion Treatments of odontoid f racture should take into consideration the Anderson and dAlonzo classification , direction of displacement, history of the fracture,and preoperative reduction.