齿状突合并周围骨折的诊断和治疗

目的：探讨齿状突合并周围骨折的诊治方法。方法：2003年1月～2006年3月我院收治新鲜齿状突骨折合并周围骨折17例。经急诊颈椎正侧位X线片、颅骨牵引后颈椎张口位及侧位X线片、CT冠状面和矢状面平扫加重建，诊断齿状突骨折合并周围骨折。采用谭明生法、Harms法和AO拉力螺钉对本组患者行寰枢椎椎弓根螺钉同定，用自体髂后上棘松质骨行寰枢椎后表面植骨融合．随访观察疗效。结果：17例齿状突骨折患者术前影像学诊断合并齿状突周围骨折20处，术中发现周围骨折5例5处．共25处骨折．平均每例患者1．5处周围骨折。所有患者手术顺利，可疑椎动脉挫伤1例。术后随访3个月～3年，平均1．4年，颈枕部疼痛1例：复查X线片显示齿状突骨折均愈合，畸形愈合3例，合并存在的25处齿状突周围骨折均愈合．无钉棒系统松动、断裂。结论：齿状突合并周围骨折是齿状突骨折的一种特殊类型，由于影像学的局限性．术前准确诊断很闲难。采用寰枢椎椎弓根螺钉短节段固定融合治疗效果满意．

Diagnosis and treatment of odontoid process fracture of dens combined with nearby structure injuries

Objective:To discuss clinical characteristic and treatment of odontoid process fracture combined with nearby structure injuries.Method:17 cases who sustained fresh fracture of odontoid process combined with nearby structure injuries were admitted to our hospital from January 2003 to March 2006.To diagnose the surrounding fractures which might exist with odontoid process fracture,X-ray about atlanto-axial region was done at emergency room and after skull traction,at same time,CT scan of coronal and sagittal section about atlanto-axial region was observed.Atlanto-axial pedicle screw fixation was performed by means of Tan,Harms and AO respectively.Fusion with autologous cancellous graft harvested from posterior supperior iliac spine was completed in posterior surface of atlanto-axial region.17 cases were followed up.Result:There were 25 surrounding fractures in these 17 cases,20 were diagnosed by image films,others were found in the operation.1.5 fractures for each patient on an average.All patients were operated successfully by pedicle screw technique of atlanto-axial spine,vertebral artery bruised was suspected in operation for 1 case.All patients were followed up from 3 months to 3 years,average 1.4 years.Pain of occipitocervical region was in 1 case.All of odontoid process were healed,but 3 cases were malunion.The surrounding fractures were all healed.There was no screw-rod breakage in atlanto-axial region.Conclusion:One of the special types of odontoid process fracture is dens combined with nearby structure fracture,it is difficult to diagnose all existing fractures nearby odontoid process because of the limitation of radiography.Occipito-atlas joint may be kept from fusion as possible as we can if pedical screw technique at atlanto-axial spine can be used appropriately.