摘要
目的探讨前路齿状突螺钉偏向置入治疗合并寰椎后脱位的齿状突骨折的疗效。方法自2002年8月至2011年12月收治合并寰椎后脱位的齿状突骨折患者18例，男10例，女8例；年龄20～50岁，平均41岁；均为新鲜脂状突骨折，骨折按照Anderson—D’Alonzo分型：Ⅱ型12例，Ⅲ型6例，术前神经功能按美国脊髓损伤协会（ASIA）分级：c级3例，D级10例，E级5例；术前颅骨牵引均不同程度复位，术中为维持寰椎复位及街状突骨折断端对位对线将头部固定在前屈靠近胸部位置，由于前屈位时下颌骨阻挡齿状突导针置入，所有患者均偏向置入前路齿状突螺钉。结果小组患者手术时间1．0～1．5h，术中出血量50～100mL，平均75mL。术后随访12～18个月（平均15个月），术后3～4个月齿状突骨折均愈合，未见断钉、退钉等情况发生；术后神经功能按ASIA分级评估：有1例患者由C级恢复至E级，1例患者由C级恢复至D级，9例患符由D级恢复至E级，其他患者无明显改变。手术前、后寰椎移位距离[（5．33±1．75）mm vs.（1．83±0．79）mm]比较，差异有统计学意义（t=10．424，P=0．000）。结论在合并寰椎后脱位的齿状突骨折治疗中，偏向置入前路街状突螺钉疗效确切，可保留寰枢椎旋转功能，为此类损伤的治疗提供了一种新心路。
Objective To investigate deflective placement of anterior odontoid cannulated screw for treatment of odontoid fracture combined with atlantoaxial posterior dislocation. Method From August 2002 tn December 2011, 18 cases of fresh odontoid fracture combined with atlantoaxial posterior dislocation were treated with deflective placement of anterior odontoid eannulated screw in our hospital. They were 10 males and 8 females, aged frmn 20 to 50 years （mean, 41 years）. According to the classification of Anderson-D＇ Alnnzon, 12 cases were type Ⅱ and 6 type Ⅲ; according to the classification of American Spinal Injury＇ Association （ASIA）, 3 cases were grade C, 10 grade D and 5 grade E. All patients underwent skull traction pre-operatlon to reduce dislocation. During the operation, the head was bent close to the chest in order to maintain atlantoaxial restoration and odnntoid reduction. Because in this posture the jawbone blocked Kirsehner wire and made the placement challenging, the anterior odontoid cannulated screw was deflected in all cases. Results In this series, the operation time ranged from 1.0 to 1.5 hours and the blood loss 50 to 100 mL （mean, 75 mL）. The mean time of follow-up was 15 months （range, 12 to 18 months）. All cases got bony union 3 to 4 months postoperation without screw failure. According to the ASIA grading for neural function, one case improved from grade C to grade E, one from grade C to grade D, 9 cases from grade D to grade E, and no improvement was noted in the other cases. The difference in atlantoaxial shift distance between prenperation and postoperation was statistically significant （ P 〈 0.05）. Conclusion In the treatment of odontoid fracture combined with atlantoaxial posterior dislocation, deflective placement of anterior odontoid cannulated screw may preserve the rotation function of the atlas and axis and lead to positive outcomes.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2013年第12期1045-1048,共4页
Chinese Journal of Orthopaedic Trauma
关键词
齿状突
寰枢关节
骨折
脱位
骨折固定术
内
Fascia dentate
Atlanto-axial joint
Fracture, bone
Dislocation
Fracture fixation, internal
