不同类型齿状突骨折的治疗方法及临床效果评价

目的 探讨不同类型齿状突骨折的相应治疗方法 及临床效果. 方法 对21例齿状突骨折患者根据Anderson-D'Alonzo分型进行分类,并予以不同方法 治疗:Ⅰ型骨折3例行枕颌带牵引+6周后头领胸石膏固定;Ⅱ型骨折13例行颅骨牵引复位后,齿状突中空螺钉固定;Ⅲ型骨折5例,行颅骨牵引复位后,1例行齿状突中空螺钉固定,4例行颈后路寰枢椎椎弓根螺钉固定.结果 随访6～48个月,平均9个月,骨折均获骨性愈合,未出现术后并发症. 结论 齿状突骨折应按类型区别处理,Ⅰ型骨折、深Ⅲ型骨折应当采用保守疗法,Ⅱ型及浅Ⅲ型骨折使用齿状突中空螺钉同定术治疗可获得满意效果,对于不适合齿状突中空螺钉治疗的浅Ⅲ型骨折,可选用颈后路寰枢椎椎弓根螺钉固定术.

Surgical treatment of different types of odontoid process fractures and clinical results

Objective To discuss surgical treatment methods for different types of odontoid process fractures and evaluate their therapeutic results. Methods Twenty-one patients with odontoid process fracture were classified into three types, ie, type Ⅰ,type Ⅱ and type Ⅲ fractures accoding to An-derson-D' Alonzo classifications. There were three patients with type Ⅰ fractures treated by traction of oc-cipital-jaw band and fixed with head-neck-chest plaster at 6 weeks and 13 with type Ⅱ fractures treated by cannulated screws following skull traction and reduction. As for five patients with type Ⅲ fractures, one was fixed with cannulated screws and the other four with atlantoaxial pedicle screw after the fracture got diaplasis by skull traction. Results All patients were followed up for 6-48 months (average 9 months), which showed bony union, with no complications in all patients. Conclusions Odontoid process fractures should be. treated according to different types. Conservative treatment for type Ⅰ fracture and cannulated screw fixation for type Ⅱ and low type Ⅲ fractures can attain satisfactory result. Aflanto-axial pedicle screw fixation can be an alternative for low type Ⅲ fractures that are not suitable for cannu-luted screw fixation.