摘要
目的评价后路寰枢椎椎弓根螺钉固定术在齿状突骨折治疗中的应用及疗效。方法本院2007年8月～2011年2月,选择寰枢椎椎弓根螺钉固定术治疗齿状突骨折的患者共18例,对其采用寰椎椎弓根螺钉置钉技术以及枢椎椎弓根螺钉置钉技术治疗。结果所有患者均获随访,随访时间8～24个月,平均16个月,经X射线、CT复查示螺钉无松动,无断钉,均获得骨性融合。1例螺钉偏内致左椎弓根内侧皮质破裂,1例螺钉穿破寰椎左侧椎弓根外侧壁,余螺钉位置良好,无脊髓、椎动脉损伤。3例术中在行寰椎后弓下方操作时损伤静脉丛,但无临床影响。4例骨折脱位完全复位,1例不完全复位;术后切口均愈合良好无感染;Frankel脊髓功能分级5例D级均恢复至E级,13例E级无变化;患者不同程度的颈枕区疼痛均完全恢复,旋转功能稍受限。结论后路寰枢椎椎弓根螺钉固定术为短节段固定,直视下置钉、复位,对颈椎影响小,寰枢椎的稳定性良好,提高了植骨融合率,脊髓功能恢复满意,是治疗齿状突骨折的有效方法。
Objective To evaluate the application and effect of the posterior pedicle screw fixation in the treatment of odontoid fracture. Methods From August 2007 to February 2011, 18 cases with odontoid fracture were selected and given atlas pedicle screws nail technology as well as the hub for vertebral pedicle screws nail technology for treatment. Results All patients were followed up for 8-24 months, with an average of 16 months. After the X-ray and CT scan verified, all cases had a solid bony union and the transpedicularscrews were in the proper position; and there was no loosening or breaking situation happened. One screw was inserted so medially as to penetrate into spinal canal. Another screw was per- forated into the lateral wall of the vertebral pedicle. But other screw were in the proper position; and there were no injuries of spinal cord and vertebral artery. Vertebral venous damage happened in another 3 cases, but without clinical conse- quences. 4 patients were fully recovered, and another one was with incomplete reduction. The wound-healing was going smoothly and well. 5 patients recovered from Frankel grade D to Frankel grade E. 13 cases remained with the Frankel grade E. Patients were cervico-occipital pain free and got slightly restricted with the rotational function. Conclusion The Posterior pedicle screw fixation has advantages of short-segment fixation, direct screw placement, intraoperative reduction and high fusion rate. It has little influence on cervical function, greatly improves atlantoaxial stability and promotes functional recovery of spinal cord. The transpedicular fixation is an effective method for the treatment of odontoid fracture.
出处
《中国当代医药》
2012年第23期41-43,共3页
China Modern Medicine
关键词
齿状突骨折
后路
椎弓根螺钉
内固定
Odontoid fracture
Posterior side
Pedicle screw
Internal fixation
