CAJ | 학술논문

目的探讨改良Brook法结合C1-2经关节突螺钉固定治疗陈旧性齿状突骨折的临床疗效. 方法自2007年1月至2010年6月通过改良Brook法结合C1-2经关节突螺钉内固定技术治疗18例陈旧性齿状突骨折患者,男12例,女6例；年龄21～68岁,平均41 8岁.骨折根据Anderson-D'Alonzo分型:Ⅱ型15例,Ⅲ型3例.其中4例合并颅脑损伤,3例合并胸部损伤.受伤至手术时间41 d至13年,平均18.4个月.结果本组患者手术时间100 ～ 180 min,平均125 min;术中出血量100～600 mL.,平均250 mL.术中无椎动脉、脊髓损伤发生.所有患者获平均30.2个月(14 ～50个月)随访.术后临床症状评价按照Mayo(McGrory)颈椎创伤后临床评分系统:优7例,良9例,可2例,优良率为88.9％.术后VAS评分(1.4±0.8)分较术前(5.3±1.2)分有明显改善,差异有统计学意义(t=15.853,P=0.000),6例合并神经症状的患者神经症状均有至少1级改善.术后6个月所有患者均获骨性融合.所有患者螺钉位置良好,在随访过程中无松动、移位、断裂等发生.结论改良Brook法结合C1-2经关节突螺钉固定是一种安全可靠的方法,为陈旧性齿状突骨折的治疗提供了一种术式选择.
목적 탐토개량Brook법결합C1-2경관절돌라정고정치료진구성치상돌골절적림상료효. 방법 자2007년1월지2010년6월통과개량Brook법결합C1-2경관절돌라정내고정기술치료18례진구성치상돌골절환자,남12례,녀6례；년령21～68세,평균41 8세.골절근거Anderson-D'Alonzo분형:Ⅱ형15례,Ⅲ형3례.기중4례합병로뇌손상,3례합병흉부손상.수상지수술시간41 d지13년,평균18.4개월.결과 본조환자수술시간100 ～ 180 min,평균125 min;술중출혈량100～600 mL.,평균250 mL.술중무추동맥、척수손상발생.소유환자획평균30.2개월(14 ～50개월)수방.술후림상증상평개안조Mayo(McGrory)경추창상후림상평분계통:우7례,량9례,가2례,우량솔위88.9％.술후VAS평분(1.4±0.8)분교술전(5.3±1.2)분유명현개선,차이유통계학의의(t=15.853,P=0.000),6례합병신경증상적환자신경증상균유지소1급개선.술후6개월소유환자균획골성융합.소유환자라정위치량호,재수방과정중무송동、이위、단렬등발생.결론 개량Brook법결합C1-2경관절돌라정고정시일충안전가고적방법,위진구성치상돌골절적치료제공료일충술식선택.
Objective To explore clinical efficacy of modified Brook's technique combined with posterior C1-2 transarticular screw fixation in the management of old odontoid fractures. Methods From January 2007 to June 2010,18 patients with old odontoid fractures were treated surgically by modified Brook' s technique combined with posterior C1-2 transarticular screw fixation in our unit.They were 12 males and 6 females with an average age of 41.8 years (from 21 to 68 years).By the Anderson-D'Alonzo classification,there were 15 cases of type Ⅱ and 3 cases of type Ⅲ.Among them,4 patients were complicated with brain injury and 3 patients with breast injury.The duration from injury to operation averaged 18.4 months,ranging from 41 days to 13 years. Results The average operative tine was 125 minutes (from 100 to 180 minutes) and the average blood loss was 250 mL (from 100 to 600 mL) in this series.No intraoperative injury occurred to the vertebral artery or to the spinal cord.All the patients were followed up for an average of 30.2 months (from 14 to 50 months).By the Mayo (McGrory) evaluation system,the postoperative clinical symptoms were rated as excellent in 7 cases,good in 9 cases and fair in 2 cases,with a good to excellent rate of 88.9％.The mean Visual Analogue Scale (VAS) score was improved significantly from preoperative 1.4 ±0.8 points to postoperative 5.3 ± 1.2 points ( t =15.853,P =0.000).The 6 patients complicated with neural injury obtained improvement by at least one grade.All the patients achieved bone fusion at 6 months postoperation,and no loosening,displacement or breakage of the screws was found in the follow-up.Conclusion As Modified Brook' s technique combined with posterior C1-2 transarticular screw fixation is a safe and reliable treatment of atlantoaxial instability,it can serve as a surgical option for old odontoid fractures.