摘要
目的分析寰枢椎后路切开复位内固定术治疗陈旧性齿突骨折伴C1,2不稳的临床疗效。方法 2008年5月-2012年5月,对32例陈旧性齿突骨折伴C1,2不稳的患者进行寰枢椎后路切开复位内固定术。根据Anderson-D’Alonzo分型,其中Ⅱ型23例,Ⅲ型9例。从受伤开始到手术治疗时间为6个月-3年,平均19个月。结果所有患者均行寰枢椎后路切开复位内固定术,术中未伤及椎动脉和脊髓。平均手术时间100 min;术中平均出血量290 mL。患者术后平均随访18个月。在术后8个月随访时,患者骨折端均获得骨性融合,随访中未出现螺钉松动、断钉、移位等情况。寰齿前间距由术前7.5 mm缩小至术后2.8 mm（P〈0.05）。日本骨科学会（Japanese Orthopaedic Association,JOA）评分由术前12.5±2.2改善至术后15.4±1.4（P〈0.05）。在末次随访中,3例患者Frankel分级从D级改善为E级。结论寰枢椎后路切开复位内固定术治疗陈旧性齿突骨折合并C1,2不稳是一种安全有效的方法。
Objective To analyze the clinical results of atlantoaxial posterior open reduction and internal fixation for old odontoid fracture with C1,2instability. Methods From May 2008 to May 2012,32 patients with old odontoid fractures combined with C1,2instability were treated with atlantoaxial posterior open reduction and internal fixation. By the Anderson-D＇Alonzo classification,there were 23 cases of typeⅡ and 9 cases of type Ⅲ. The duration from injury to operation averaged 19 months,ranging from 6 months to 3 years. Results All patients were performed atlantoaxial posterior open reduction and internal fixation,no intraoperative vertebral artery injury and spinal cord injury occurred. The average operative time was 100 minand the average blood loss was 290 mL. Patients were followed up for an average of 32 months,all the patients achieved bone fusion at 6 months postoperation,and no loosening,breakage or displacement of the screws was found in the follow-up. The atlanto-dens interval（ ADI） was decreased from 7. 5 mm preoperative to 2. 8 mm postopertive（ P〈0. 05）. The Japanese Orthopaedic Association（ JOA） score was improved from 12. 5 ± 2. 2 preoperative to 15. 4 ± 1. 4 postoperative（ P〈0. 05）. At the final follow-up,according to the Frankel classification,3 patients had improved from grade D to grade E. Conclusion Atlantoaxial posterior open reduction and internal fixation was an safe and effective method for old odontoid fracture with C1,2instability.
出处
《脊柱外科杂志》
2014年第3期138-142,共5页
Journal of Spinal Surgery
关键词
寰枢关节
齿突尖
脊柱骨折
脱位
内固定器
Atlanto-Axial Joint
Odontoid Process
Spinal fractures
Dislocations
Internal fixators
