经皮前路空心钉内固定治疗新鲜Ⅱ型齿状突骨折

目的 评价经皮前路空心钉内固定治疗新鲜Ⅱ型齿状突骨折的临床疗效。方法 自2009-05-2013-02采用经皮前路空心钉内固定治疗新鲜Ⅱ型齿状突骨折15例,根据Anderson-D＇Alonzo分型方法,均为Ⅱ型。记录手术时间、术中出血量、住院时间及并发症情况,术后摄X线片观察寰枢椎稳定和内固定物位置情况。结果 手术时间84-125 min,平均98.7 min;术中出血量8-30 ml,平均11.2 ml。15例均获得良好复位,切口均一期愈合。本组获得随访10-21个月,平均13.8个月。X线片显示骨折均愈合,螺钉位置良好,寰枢椎稳定。骨折愈合时间4-9个月,平均6.8个月;无血管、神经、气管及内固定物失效等并发症。结论 采用经皮前路空心钉内固定治疗新鲜Ⅱ型齿状突骨折,具有创伤小、恢复快及骨折足够稳定性等特点,是治疗Ⅱ型齿状突骨折较为理想的方法,但应严格掌握手术适应证。

Treatment of fresh type lI odontoid fractures with closed reduction and percutaneous screw fixation

Objective To evaluate the results of the treatment of fresh type II odontoid fractures with closed reduction and percutaneous screw fixation. Methods From May 2009 to February 2013, 15 cases of fresh Anderson-D＇Alonzo type Ⅱ odontoid fractures were treated with closed reduction and percutaneous screw fixation. Eleven were males and 4 were females, aged 42 to 67 years （51.3 years on average）. The operative time,intra-operative blood loss, length of stay and compheations were recorded. During follow-up, the atlantoaxial stability and implant position were evaluated with X-ray films. Results The average operation time was 98.7 minutes （range, 84-125 minutes）.The average intra-operative blood loss was 11.2 ml （range, 8-30 ml）. Good reduction of atlantoaxial joint and primary healing of incision were obtained in 15 patients. The average foUow-up duration was 13.8 months with a range of 10-21 months. All cases showed fracture healing during 4 to 9 months（mean 6.8 months）. The X-ray films showed odontoid bony union, atlantoaxial stability and good position of screws. No major complications of carotid artery laceration,nerve injury, airway obstruction,and implant failure occurred. Conclusion Pereutaneous screw fixation of fresh type Ⅱ odontoid fractures is associated with minimally invasive surgical advantages, early rehabilitation and excellent results. The procedure is the most suitable for type Ⅱ odontoid fractures, but the operation indications must be strictly controlled.