摘要
目的 通过临床解剖测量和生物力学试验，探讨齿状突Ⅱ型骨折直接螺丝钉内固定的方法。 方法 选择４５ 具国人枢椎骨标本和５０ 例正常成人颈椎标准Ｘ 线侧位片，测量枢椎的相关外径和齿状突倾角；选用１０ 例新鲜寰枢椎骨韧带标本，利用ＳＷＤ－ １０ 型万能材料机和５０ －ＮＪＢ扭转试验机，测试齿状突骨折后３ 种不同螺丝钉内固定前后水平方向的剪切刚度及扭转刚度。临床选用６ 例新鲜齿状突Ⅱ型骨折病人，采用单枚直径４．５ ｍｍ 的加压螺丝钉内固定治疗。 结果 国人齿状突难以容纳２ 枚直径３．０ ｍｍ 或３ ．５ ｍｍ 螺丝钉，宜以单枚固定为好，直径控制在４．０～４ ．５ ｍｍ 。加压螺丝钉内固定治疗后，仅能提供５０ ％ 正常状态下的稳定性，亦需适宜的外固定。经６ ～３０ 个月随访，６ 例均骨性愈合，枕颈部恢复至伤前活动范围。 结论 国人齿状突Ⅱ型、浅Ⅲ型骨折，应首选单枚直径４．０ ～４．５ ｍｍ 加压螺丝钉直接内固定治疗。
Objective To find a method for treatment of type Ⅱ odontoid fracture with direct screw internal fixation by clinical anatomical measure and biomechanical test. Methods The relative dimensions and inclination of 45 dry axis specimens were surveyed. Standard lateral cervical radiographs of 50 normal adults were also measured. Ten fresh cadaveric specimens of articulatio vetebra were prepared; and the anterior, posterior horizontal shearing and torsional rigidity after three different screw internal fixation by using type SWD 10 material testing machine and 50 NJB torsion testing machine were measured. In clinic, 6 patients with new type Ⅱ odontoid fracture were directly internally fixed with a 4.0 4.5 mm compressing screw. Results The Chinese Dens could not hold two screws with dimension of 3.0 mm or 3.5 mm. The proper diameter for compresing screw was 4.0 4.5 mm. After internal fixation, the compressing screw only provided 50 per cent of stability in the normal state. An external fixation was also needed. After 6 30 months of follow up study, 6 patients recovered with fracture healing to the normal motion ranges. Conclusions For type Ⅱ and type Ⅲ odontoid fracture in our country, one 4.0 4.5 mm compressing screw direct internal fixation should be the treatment of choice.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2000年第1期20-22,共3页
Chinese Journal of Trauma
