不同类型齿状突骨折的外科治疗策略

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分型进行不同方法 治疗:Ⅰ型骨折3例枕颌带牵引+6周后头颈胸石膏固定;Ⅱ型骨折13例行颅骨牵引复位后齿状突中孔螺钉固定;Ⅲ型骨折5例,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固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.

Clinical analysis of surgical treatment of odontoid fracture

Objective To evaluate the therapies and clinical outcome for different types of odontoid process fracture. Methods Twenty-one patients with odontoid process fracture were treated with different therapies for different Anderson-D'Alonzo classifications: three cases of type Ⅰ were treated by traction of occipital-jaw band and fixed with head-neck-chest plaster at 6 weeks; thirteen cases of type Ⅱ were treated by cannulated screws following skull traction and reduction; and for the cases of type Ⅲ , one was fixed with screw when the fracture was reduced by skull traction, and four with atlantoaxial pedicle screw. Results All cases were followed up for a mean of 9 months (range; 3-48). All cases achieved bony union. No postoperative complication was found. Conclusion Odontoid process fracture should be treated according to different types. Conservative treatment for type Ⅰ fracture and cannulated screws for type Ⅱ and low type Ⅲ fracture can obtain a satisfactory outcome. Atlantoaxial pedicle screw should be chosen if the superficial type HI fracture is not suitable for cannulated screw.