经口咽入路寰椎前路钢板固定治疗不稳定性寰椎骨折

 目的探讨经口咽入路寰椎前路钢板内固定治疗不稳定性寰椎骨折的临床疗效。 方法2004年3月至2010年5月,采用经口咽入路寰椎前路钢板内固定治疗不稳定性寰椎骨折患者20例,男12例,女8例;年龄23~68岁,平均(47.7±13.9)岁。4例为寰椎前1/2 Jefferson骨折;8例为半环 Jefferson骨折;8例为前3/4 Jefferson骨折。患者均有不同程度的颈枕区疼痛,活动受限。疼痛视觉模拟评分(visual analog scale,VAS)为4~8分,平均(6.0±1.3)分。20例患者均选择行经口咽入路寰椎前路钢板内固定,随访通过临床和影像学检查评价其疗效。结果所有患者均获得随访,随访时间12~81个月,平均(48.5±20.0)个月。术中未出现螺钉松动、断裂,钢板移位,脊髓损伤,椎动脉损伤。20例患者共放置钢板20块,置入寰椎侧块螺钉40枚。术后CT显示有2枚螺钉过于靠近椎动脉沟,但是未出现临床症状。术后VAS评分为0~3分,平均(1.3±1.0)分。静态和动态的影像学资料显示,术后6个月所有患者均达到骨性愈合,寰枢关节旋转功能良好。随访期间无一例出现内植物相关的并发症。结论寰椎前路钢板内固定能获得坚固的骨性愈合和较低的并发症发生率,是治疗不稳定性寰椎骨折的一种有效方法。

Unstable atlas fractures treated by anterior plate fixation through transoral approach

Objective To explore the clinical outcomes of anterior plate fixation through transoral approach in the treatment of unstable atlas fractures. Methods From March 2004 to May 2010, 20 patients with unstable atlas fractures were treated by anterior plate fixation through transoral approach, including 12 males and 8 females, aged from 23 to 68 years (average, 47.7?13.9 years). Of the 20 cases of unstable atlas fractures, 4 cases were classified as anterior 1/2 Jefferson fracture, 8 cases as 1/2 ring Jefferson fracture, and 8 cases as anterior 3/4 ring Jefferson fracture. The preoperative average VAS scores were 6.0?1.3 points, ranged from 4 to 8 points. Clinical and imaging examinations were performed during follow-up period to evaluate the outcomes. Results All patients were followed up for 12 to 81 months, with an average of 48.5?20.0 months. There were no screw loosing and breakage, no plate displacement, and no spinal cord and vertebral artery injury during operation. A total of 20 plates were placed and all 40 screws were inserted into atlas lateral mass. Computed tomography scans demonstrated 2 screws were placed too close to the vertebral artery canal, but without clinical consequences. The postoperative VAS scores were from 0 to 3 points with an average of 1.3?1.0 points. Static and dynamic films 6 months after surgery demonstrated that fusion was achieved in all cases. Atlantoaxial rotational function was restored satisfactorily. No plate-related complication was observed in all patients in the whole follow-up period. Conclusion Anterior plate fixation through transoral approach is an effective method for management of unstable atlas fractures, which has advantages such as solid bony fusion and low incidence of complication.