前路单枚螺钉治疗齿状突骨折的临床观察

目的 评价颈前路单枚螺钉内固定治疗齿状突骨折的临床疗效.方法 对23例齿状突骨折行颈前路单枚螺钉内固定术.结果 患者均获得随访,平均随访11个月,骨折愈合良好,颈椎活动基本恢复正常,无螺钉松动、断裂.21例临床症状完全消失,2例有颈部僵硬感.结论 颈前路单枚螺钉内固定是治疗齿状突骨折的一种有效方法,可最大限度的保留寰枢椎的生理活动功能.     

颈前路双空心螺钉内固定治疗成人游离粉碎型齿状突骨折

目的:探讨颈前路双空心螺钉内固定治疗成人游离粉碎型齿状突骨折的疗效。方法:应用颈前路双空心螺钉内固定治疗8例成人游离粉碎型齿状突骨折。按Anderson-D'Alonzo分型,Ⅱ型5例,Ⅲ型3例。结果:7例获得平均13个月随访,骨折复位满意,均获骨性愈合,未出现术中、术后并发症,1例遗留颈部僵硬感,但临床检查无活动受限。结论:颈前路双空心螺钉内固定治疗成人游离粉碎型齿状突骨折效果良好。     

颈前路空心螺钉内固定治疗齿状突骨折

目的探讨颈前路空心螺钉内固定治疗齿状突骨折的临床疗效。方法对25例Ⅱ型、5例浅Ⅲ型齿状突骨折采用空心螺钉内固定。结果30例中28例获得随访,均骨性愈合。结论单枚空心螺钉内固定治疗齿状突骨折,具有复位效果好、骨性愈合率高的效果。     

前路三钉内固定治疗寰椎-齿状突Ⅱ型骨折

背景：齿状突加寰枢椎前路经关节螺钉内固定是近来治疗寰椎-齿状突Ⅱ型骨折的一种新方法,临床报道较少。 目的：探讨颈前路三钉,即齿状突螺钉加寰枢椎前路经关节螺钉内固定治疗寰椎-齿状突Ⅱ型骨折的方法及疗效。 方法：2008年2月至2011年10月于C型臂X线机透视下行颈前路齿状突螺钉加寰枢椎经关节螺钉内固定治疗寰椎-齿状突Ⅱ型骨折5例。 结果：5例骨折患者共植入5枚齿状突螺钉,9枚经寰枢关节螺钉,1例因左侧经寰枢关节螺钉进钉点处骨折而行右侧单侧固定。全部获得随访,随访时间为10~30个月,平均18个月,螺钉位置满意,齿状突骨折均获骨性愈合,寰枢关节稳定,无一例发生螺钉松动、断钉,无一例发生脊髓、椎动脉损伤等并发症。 结论：颈前路齿状突螺钉加寰枢椎经关节螺钉内固定治疗寰椎-齿状突Ⅱ型骨折,对齿状突直接固定同时即刻稳定寰枢椎,为寰椎-齿状突Ⅱ型骨折患者提供了一种新的治疗方法。     

颈前路加压螺丝内固定治疗齿状突骨折

目的评价颈前路加压螺钉内固定在治疗齿状突骨折中的应用及效果。方法对9例急性齿状突骨折的患者，在透视监视下行颈前路加压螺钉内固定术并分析其结果。结果9例患者中，术后除1例病人出现短暂左上肢无力外，余均获得了满意疗效。随访11～42个月，平均17个月，齿状突骨折愈合良好，无不稳定或假关节形成。结论前路直接加压螺钉内固定是治疗齿状突骨折的一种有效方法，在重建环枢复合体稳定性的同时，完全保留了其间的运动功能。精确的操作技术和恰当的适应证选择是手术成功的关键。     

齿状突螺钉加压固定治疗齿状突骨折

目的：探讨颈前路齿状突螺钉加压固定治疗齿状突骨折的临床效果。方法：对15例齿状突骨折采用牵引复位后行前路单枚齿状突螺钉加压内固定方法治疗。结果：随访6个月－4年2个月，平均11个月，X线片及临床检查骨折均获得骨性愈合，均无明显颈部活动受限。无螺钉移位、断裂等并发症。临床症状完全消失13例，明显减轻2例。结论：前路齿状突螺钉固定牢靠，同时最大限度地保存了寰枢椎的生理活动功能。术前良好的复位是本手术成功的重要前景。     

颈前路单枚螺钉内固定治疗齿状突骨折

目的 探讨颈前路单枚螺钉内固定治疗齿状突骨折的临床疗效.方法 对8例Ⅱ型和Ⅲ型齿状突骨折的患者在透视下行颈前路单枚螺钉内固定术,所有患者术前行颅骨牵引复位,术后使用颈托外固定3个月.结果 随访时间6～24个月,平均12个月,本组全部骨折愈合良好,未出现内植物断裂或感染等并发症,颈椎活动基本正常,旋转(90.2±16.8)°,屈伸(40.5±10.1)°,有1例出现螺钉后退.结论 颈前路单枚螺钉内固定治疗Ⅱ型和Ⅲ型齿状突骨折具有良好的稳定性,保留了寰枢关节运动功能,骨折愈合率较高,并发症低.     

成人新鲜Ⅱ型、浅Ⅲ型齿状突骨折手术治疗效果分析

目的 :探讨颈前路齿状突螺钉内固定术和颈后路寰枢椎椎弓根螺钉内固定植骨融合术治疗成人新鲜Ⅱ型、浅Ⅲ型齿状突骨折的临床疗效。方法:回顾分析我院2010年3月~2016年3月手术治疗的成人新鲜齿状突骨折23例,根据Anderson-D′Alonzo分型,Ⅱ型17例,浅Ⅲ型6例,男15例,女8例,年龄15~68岁(41.2±15.1岁)。患者入院时均有颈部疼痛、颈部活动受限;其中5例有不同程度脊髓神经损伤表现,术前JOA评分10~14分(12.8±1.6分)。13例齿状突骨折无移位或牵引后复位良好的Ⅱa型、Ⅱb型、浅Ⅲ型患者行颈前路齿状突螺钉内固定术,8例牵引后复位不理想及2例Ⅱc型齿状突骨折患者行颈后路寰枢椎椎弓根螺钉内固定植骨融合术。结果:术后23例患者均未出现血管、食道损伤及脊髓神经损伤加重等并发症。术后23例患者随访8~30个月(18.0±6.4个月)。5例合并脊髓损伤患者术后半年JOA评分14~17分(16.3±1.3分),平均改善率为83.3%。术后影像学复查寰枢椎对应关系良好,内固定无松动、断裂。术后1例前路齿状突螺钉内固定患者随访至8个月时骨折端尚未愈合,其余12例齿状突螺钉内固定均骨性愈合。10例寰枢椎椎弓根螺钉内固定植骨患者植骨均获得骨性融合。结论:颈前路齿状突螺钉内固定和颈后路寰枢椎椎弓根螺钉内固定植骨融合术治疗成人新鲜Ⅱ型、浅Ⅲ型齿状突骨折,固定牢固,愈合率高,具有良好的临床疗效。     

颈前路单枚空心螺钉治疗齿状突Ⅱ型骨折疗效分析

目的探讨颈前路单枚齿状突空心螺钉治疗Ⅱ型齿状突骨折的疗效。方法 2005年8月至2010年7月,我科收治35例Ⅱ型齿状突骨折（屈曲型25例,伸展型10例）,男23例,女12例;年龄15～71岁,平均34岁。患者均未见明显神经压迫症状,术前均行颅骨牵引,完全复位30例,未完全复位5例。为防止术后骨不连,所有患者行颈前路电视下闭合复位单枚空心螺钉内固定术。结果所有患者均获得随访,随访时间6～60个月,平均36个月,平均手术时间105min,颈部疼痛症状完全缓解,颈椎生理曲度保持良好,骨折愈合率100%,无内固定松动、断钉等并发症。结论应用颈前路单枚齿状突空心螺钉治疗Ⅱ型齿状突骨折,是一种安全、有效的治疗方法。     

颈前路加压螺钉固定治疗齿状突骨折

目的：分析颈前路加压螺钉内固定治疗齿状突骨折的临床疗效。方法：对8例新鲜齿状突Ⅱ型骨折在C型臂X线机监视下行前路加压螺钉内固定治疗，分析其结果及并发症。结果：随访4个月-3年1个月，平均10个月，X线片示骨折均获骨性愈合，无明显颈部运动受限，无螺钉断裂、移位及神经损伤等并发症，临床症状完全消失7例，1例合并颅脑损伤者残留部分头痛、头晕。结论：颈前路加压螺钉内固定技术是治疗Ⅱ型齿状突骨折可供选择的方法，具有损伤小、并发症少、固定牢靠及愈合率高等优点，能最大限度地保留寰枢椎的生理活动功能。     

Acute combination fracture of atlas and axis: "triple" anterior screw fixation in a 92-year-old man: technical note

BACKGROUND: The combination of odontoid and bilateral transarticular C1-C2 anterior screw fixation is a recent addition in treating C1-type II odontoid fractures. When feasible, it ensures early maximal stability, even if it slightly reduces the mobility of C1-C2 complex. We report a case of combination atlas-type II odontoid fracture that occurred in a 92-year-old man. The instability was treated with odontoid screw fixation and anterior bilateral C1-C2 transarticular screw fixation in a single stage. The aim of the article is to describe the feasibility of "triple" anterior screw fixation in the presence of C1-type II odontoid fracture. METHODS: The diagnosis, treatment, and outcome of a 92-year-old patient with mild tetraparesis caused by C1-type II odontoid fracture were assessed. RESULTS: Cervical x-rays, computed tomographic scan, and magnetic resonance imaging demonstrated a fracture of posterior arch of C1, associated with type II odontoid fracture and with presumable damage of C1 transverse ligament. Magnetic resonance imaging also showed a high cervical centromedullary area slightly hyperintense in T1-weighted images. Treatment consisted of odontoid and bilateral C1-C2 transarticular screw fixation with single anterior approach. The admission neurologic conditions improved and the patient was early mobilized. CONCLUSIONS: The authors suggest that in presence of C1-type II odontoid fracture, the triple anterior screw fixation has to be taken into account as salvage procedure, especially if other methods of stabilization failed or cannot be safely performed. This technique seems to be safety feasible also in old patients, as our report and the experience of others confirm.     

经皮前路螺钉固定治疗枢椎齿状突骨折

 目的 回顾性分析经皮和开放前路螺钉固定治疗枢椎齿状突骨折, 比较两种方法的临床和影像学结果。方法 2003年 3月至 2010年 5月, 115例齿状突骨折患者接受前路螺钉固定治疗并获得随访。年龄 16~71岁, 平均 43.5岁。经皮固定组 47例: 域型骨折 42例, 浅芋型骨折 5例;采用经皮工作通道下前路螺钉固定。开放固定组 68例: 域型骨折 61例, 浅芋型 7例;采用传统开放手术方法治疗。分析两组手术时间、术中出血量、术者放射线暴露时间、骨折愈合和并发症等方面的差异。结果 115例患者均获得随访, 随访时间 12~70个月, 平均 37.6个月。术前两组性别、年龄、骨折类型、受伤至手术时间、伴发脊柱损伤情况差异无统计学意义。平均手术时间: 经皮固定组(40.3±9.5) min, 开放固定组(62.9±15.3) min, 经皮固定组显著短于开放组(P约 0.05)。术中平均出血量: 经皮固定组(5.6±4.1) ml, 开放固定组(47.1±28.6) ml, 经皮固定组显著少于开放组(P约 0.01)。两组在术者放射线暴露时间、骨折愈合情况和并发症发生率方面差异无统计学意义。结论经皮前路螺钉固定是一种安全有效的治疗域型或浅芋型齿状突骨折的方法, 与开放固定法比较创伤相对小。     

颈前路中空螺丝钉内固定治疗齿突骨折

目的评估颈前路中空螺丝钉内固定治疗齿突骨折的临床疗效。方法对15例新鲜齿突骨折的患者行颈前路中空螺丝钉内固定，AndersonⅡ型骨折11例，浅Ⅲ型4例，观察术后骨折愈合、颈部功能状态以及术后并发症情况。结果随访3～24个月，平均6个月，骨折均获骨性愈合，均无明显颈部活动受限，未出现明显的术后并发症。结论如严格掌握手术适应证，颈前路齿突螺钉内固定可以获得良好的治疗效果，其主要优点在于保存了寰枢椎生理活动，骨折愈合率高以及术后并发症相对较少。     

新鲜Ⅱ A型齿突骨折的外科治疗

目的探讨新鲜ⅡA型齿突骨折的治疗方法的选择。方法 2006年1月—2012年12月,空军总医院骨科收治新鲜ⅡA型齿突骨折13例,其中5例采用Halo-vest支架外固定治疗(外固定组),8例采用前路齿突螺钉内固定治疗(内固定组)。以疼痛视觉模拟量表(VAS)评分、SF-36评分、并发症发生率、融合率作为指标评价疗效。结果术后2组患者VAS评分较术前均有不同程度降低。内固定组SF-36评分明显高于外固定组。5例外固定组患者术后12周时3例骨折愈合,2例未融合者延长佩戴时间,末次随访时全部骨折愈合。8例内固定组患者术后12周时全部骨折愈合。外固定组发生钉道感染1例,螺钉松动2例,骨折畸形愈合1例。内固定组发生螺钉退出1例。结论前路齿突螺钉内固定适用于治疗无手术禁忌证的ⅡA型齿突骨折,Halo-vest支架适用于有前路齿突螺钉手术禁忌证的ⅡA型骨折。     

Experience in surgical treatment of typeⅡodontoid fractures:A report of two cases and review of the literature

Two cases of typeⅡodontoid fractures were reported to share our experience in surgery treatment of such cases.A 33-year-old woman with comminuted typeⅡodontoid fracture and a 42-year-old man with fracture end hardened typeⅡodontoid fracture received surgical treatment in our hospital.Though imaging examination suggested that these two patients were suitable for anterior screw fixation,we encountered difficulties during the operation.The two patients eventually underwent posterior C1–C2 fusion surgery and recovered well.According to the experience of these two cases,we found that the fracture line angle and the degree of comminution are two important factors affecting surgical decision-making.Although anterior screw fixation is the ideal choice for typeⅡodontoid fractures with anterior superior to posterior inferior fracture line,it may not be the best choice for comminuted or fracture end hardened typeⅡodontoid fractures.     

Robot‐assisted Anterior Odontoid Screw Fixation: A Case Report

Anterior odontoid screw fixation has been proved to be effective but technically challenging because the difficult approach is associated with high risks of screw malposition and damage to surrounding vital structures. Navigation techniques are therefore increasingly being used to improve safety and accuracy. However, no robot‐assisted odontoid screw fixation has yet been reported. We here report a 61‐year‐old woman with a type II dens fracture on whom anterior odontoid screw fixation was performed under the guidance of a newly developed robotic system (TiRobot, co‐designed by Beijing Jishuitan Hospital and TINAVI Medical Technologies). One odontoid screw was safely and accurately placed, the calculated deviation between the planned and actual positions being 0.9 mm. No intraoperative complications were identified and the patient was discharged on Day 5. Follow‐up studies after 2 weeks showed good clinical and radiological results. We believe this is the first reported case of robot‐assisted anterior odontoid screw fixation. We consider that complicated procedures can become feasible, safe and accurate using TiRobot systems.     

Odontoid fractures: A retrospective analysis of 53 cases

Background:

The management of odontoid fracture has evolved but controversy persists as to the best method for Type II odontoid fractures with or without atlantoaxial (AA) instability. The anterior odontoid screw fixation can be associated with significant morbidity while delayed odontoid screw fixation has shown to be associated with reasonable good fusion rates. We conducted a retrospective analysis to evaluate the outcome of a trial of conservative management in type II odontoid fractures without atlantoaxial instability (Group A) followed by delayed odontoid screw fixation in cases in which fusion was not achieved by conservative treatment. The outcome of type II odontoid fracture with AA subluxation (Group B) was also analysed where closed reduction on traction could be achieved and in those atlantoaxial subluxations that were irreducible an intraoperative reduction was done.

Materials and Methods:

A retrospective evaluation of 53 cases of odontoid fractures treated over a 9-year period is being reported. All odontoid fractures without AA instability (n=29) were initially managed conservatively. Three patients who did not achieve union with conservative management were treated with delayed anterior screw fixation. Twenty-four cases of odontoid fractures were associated with AA instability; 17 of them could be reduced with skeletal traction and were managed with posterior fusion and fixation. Of the seven cases that were irreducible, the initial three cases were treated by odontoid excision followed by posterior fusion and fixation; however, in the later four cases, intra operative reduction was achieved by a manipulation procedure, and posterior fusion and fixation was performed.

Results:

Twenty-six of 29 cases of odontoid fracture without AA instability achieved fracture union with conservative management whereas the remaining three patients achieved union following delayed anterior odontoid screw fixation. 17 out of 24 odontoid fracture with atlantoaxial dislocation could be reduced on traction and these patients underwent posterior fusion and fixation. Optimal or near optimal reduction was achieved by on table manipulation in four cases which were irreducible with skeletal traction. Atlantoaxial stability was achieved in all cases. All cases were noted to be stable on evaluation with x-rays at six months.

Conclusions:

The initial conservative management and use of odontoid screw fixation only in cases where conservative management for 6–12 weeks has failed to provide fracture union have shown good outcome in type II odontoid fracture without AA instability rates. Intraoperative manipulation and reduction in patients where AA subluxation failed to reduce on skeletal traction followed by posterior fusion obviates the need for transoral odontoid excision.     

颈前路空心钉内固定治疗Ⅱ型齿状突骨折的临床研究

目的探讨颈前路空心钉内固定治疗型齿状突骨折的临床意义。方法回顾分析2003年7月至2006年12月我们对齿状突骨折Anderson-D′Alonzo型12例进行的颈前路空心钉内固定治疗的疗效,其中新鲜骨折10例,骨折不愈合2例。结果随访6-41个月,平均10个月,12例骨折均获得骨性愈合,临床症状完全消失,均无明显颈部活动受限。结论前路空心钉内固定治疗齿状突骨折能有效促进骨折愈合和能够最大限度的维持和重建寰枢椎的稳定性。     

经皮前路空心螺钉内固定治疗Ⅱ型齿状突骨折

目的探讨经皮空心螺钉对Ⅱ型齿状突骨折的内固定疗效。方法对11例Ⅱ型齿状突骨折患者行经皮前路空心螺钉内固定治疗。结果经过5～18（7．5±1）个月随访，11例骨折均愈合，临床症状完全消失9例，明显改善2例。无脊髓神经损伤并发症，内固定物无松动、断裂，咽部无异物感不适。结论经皮前路空心螺钉内固定治疗Ⅱ型齿状突骨折手术创伤小，恢复快，并保留了寰枢椎的生理活动功能。