经后路寰枢椎椎弓根螺钉内固定治疗陈旧性齿突骨折

目的探讨经后路寰枢椎椎弓根螺钉内固定治疗陈旧性齿突骨折的临床疗效。方法 7例患者中,AndersonⅡ型陈旧性齿突骨折6例,不稳定Ⅲ型1例,术前日本骨科协会（JOA）评分为6~13分,平均9.6分,影像学检查均伴有寰枢椎不稳或脱位表现。采用经寰枢椎椎弓根螺钉进行固定,并在寰枢椎后弓间植入自体颗粒状骨。结果 7例患者全部得到随访,平均随访15个月,所有患者螺钉植入位置和复位均满意。寰枢椎植骨于术后6~9个月达骨性融合。术后3个月JOA评分12~17分,平均14.6分。所有患者颈部运动功能恢复良好,但轴向旋转活动部分丧失。结论应用寰枢椎椎弓根螺钉内固定治疗陈旧性齿突骨折可使寰枢椎获得即刻的坚强固定,有利于寰枢间植骨融合,疗效满意。

Posterior transpedicular screw internal fixation in atlas for old fracture of odontoid process

Objective To explore the therapeutic effects of posterior transpedicular screw internal fixation in atlas for old fracture of odontoid process.Methods Of the seven patients,six patients were Anderson typeⅡold fracture of odontoid process and one patient was Anderson typeⅢ.The scores given by Japanese Orthopaedic Association（JOA） before operation ranged from 6 to 13 with an average of 9.6.Atlantoaxial instability or dislocation was observed in all patients by image examination.Transpedicular screw internal fixation was performed to stabilize atlas and axis and the granulated autogenous bone was planted onto the surface of the posterior arches in both atlas and axis.Results All patients were followed up for an average of 15 months.All screws were successfully placed in atlas and axis and the cases of atlantoaxial dislocation were reduced.Bony fusion was observed within six to nine months after operation.The JOA scores three months after operation ranged from 12 to 17,with an average of 14.6.Atlantoaxial rotational function in all patients restored satisfactorily,but axial rotation was partially lost.Conclusion Posterior transpedicular screw internal fixation can make the atlantoaxial joint stable immediately and promote the bone fusion.It is an effective method for treating old fracture of odontoid process.