摘要
目的探讨齿状突骨折本身及其相邻节段损伤的外科手术方式及其疗效。方法回顾性分析2005年1月至2012年6月手术治疗的37例齿状突骨折患者的临床资料，其中男26例，女11例；年龄21—65岁，平均36岁。单纯齿状突骨折25例，其中Ⅱ型20例，浅Ⅲ型5例；合并相邻节段不稳12例：齿状突骨折合并寰枢椎不稳6例；齿状突骨折合并C2／3不稳4例；齿状突骨折合并C1／2及C2／3同时不稳2例；神经损伤12例，Frankel分级A级1例，B级2例，C级3例，D级6例。手术在稳定齿状突骨折的同时，兼顾相邻节段不稳情况，选择个性化的固定方式。术前、术后3个月进行JOA评分，有脊髓损伤者采用Frankel评分标准，术后随访x线或CT片评价骨折愈合、植骨融合及颈椎稳定性情况。结果37例均顺利完成手术，术中无明显椎动脉损伤、神经损伤、气管食管损伤等手术并发症。随访12～48个月，平均18个月。术前JOA评分（12．1±2．1）分，术后3个月（15．4±3．2）分，两者比较差异有统计学意义（t=13．464，P=0．000）；临床JOA改善率（90．8％±11．6％），优良率98％。术后6个月Frankel分级，除1例B级无恢复外，其余Frankel分级平均提高1—2级。术后佩戴颈托3个月。9个月内X线片复查示骨折愈合良好，植骨融合者在3～6个月内均获骨性融合（平均4．5个月）；颈椎序列良好，颈椎伸屈侧位片显示颈椎稳定；无内固定松动、脱出及断裂。结论根据齿状突骨折本身特点结合有无合并相邻节段不稳情况，选择合理的手术方法，在稳定齿状突骨折同时将相邻不稳的节段固定，能取得良好的疗效。
Objective To explore the characteristics of both odontoid fractures and adjacent section instability so as to devise proper surgical strategies and achieve better curative effect. Methods A total of 37 patients （including 26 males and 11 females） with odontoid fractures treated from January 2005 to June 2012 with a mean age of （21 -65 ） 36 years were analyzed retrospectively. Among 25 cases of simple odontoid fractures, there were type II （n =20） and low type III （n =5）. There were 12 cases of odontoid fractures with adjacent section instability with C1/2 instability （ n = 6）, C2/3 instability （ n = 4） and C1/2 and C2/3 instability （ n = 2 ）. The Frankel scale was used to assess nerve function. There were Grade A （ n = 1 ） , Grade B （ n = 2） , Grade C （ n = 3 ） and Grade D （ n = 6 ） at preoperation. Treatment included anterior and/or posterior pedicle screw fixation for reducing fracture and stabilizing upper cervical vertebrae. The Japanese Orthopedic Association （JOA） standards were used to evaluate the therapeutic effect. According to Frankel grade, nerve functional restoration of spinal cord injury was gauged. Fracture healing, bone graft fusion and spinal stability were monitored by radiology or computed tomography. Results All patients underwent surgery safely without severe complications. The average follow-up period was 18 （ 12 - 48） months. There was significant difference （t = 13. 464, P =0. 000） in JOA score between pre-operation （ 12. 11 ± 2. 09） and post-operation （ 15.36 ± 3. 17 ）. And the rate of improvement was 90. 8% ± 11.6% and that of ＂excellent＂ or ＂good＂ 98%. Degree 1 -2 recovery of neural function was achieved in all except for 1 case of Frank＆ B. All patients were immobilized in a hard collar for 3 months postoperatively. Fusion occurred in all cases within a mean time of （3 -6） 4. 5 months. Radiology confirmed a proper screw position at postoperation. There were no occurrences of such complications as loosenin
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第27期2122-2125,共4页
National Medical Journal of China
基金
上海市卫生局科研基金（2007032）
上海市科委基础研究重点项目（11JC1410102）
关键词
骨折
颈椎
关节不稳定性
外科手术
Fractures
Cervical vertebrae
Joint instability
Surgical procedures,operative
