CAJ | 학술논문

目的探讨GrauerⅡ型(ⅡA、ⅡB、ⅡC型)齿状突骨折治疗方式的选择及临床疗效。方法本组共40例新鲜齿状突骨折患者，按照Grauer分型：ⅡA型7例，ⅡB型18例，ⅡC型15例；5例伴有不完全性脊髓损伤。7例ⅡA型患者先行枕颌带或颅骨牵引，后改用头颈胸石膏或支具外固定；15例ⅡB型患者行前路齿状突中空螺钉内固定；15例ⅡC型、3例严重移位ⅡB型患者经后路行寰枢椎椎弓根钉棒系统内固定植骨融合术。结果 40例患者随访6～ 24个月。7例ⅡA型患者经保守治疗3-6个月骨折愈合。15例ⅡB型患者螺钉位置良好，未出现脊髓损伤，其中14例术后3～6个月骨性愈合，愈合率93.3％；15例ⅡC型、3例严重移位ⅡB型患者术中未出现椎动脉和脊髓损伤，后路植骨3～6个月骨性融合；复查内置物位置良好，无变形、松动或断裂；5例伴有脊髓不全损伤患者术后脊髓神经功能均有不同程度改善。结论 Grauer分型中ⅡA型齿状突骨折可以保守治疗，ⅡB型(无移位或经牵引复位)宜行前路齿状突中空螺钉内固定术，ⅡC型及严重移位ⅡB型则应经后路行寰枢椎椎弓根钉棒系统内固定植骨融合术治疗。
목적 탐토GrauerⅡ형(ⅡA、ⅡB、ⅡC형)치상돌골절치료방식적선택급림상료효。 방법 본조공40례신선치상돌골절환자，안조Grauer분형：ⅡA형7례，ⅡB형18례，ⅡC형15례；5례반유불완전성척수손상。7례ⅡA형환자선행침합대혹로골견인，후개용두경흉석고혹지구외고정；15례ⅡB형환자행전로치상돌중공라정내고정；15례ⅡC형、3례엄중이위ⅡB형환자경후로행환추추추궁근정봉계통내고정식골융합술。 결과 40례환자수방6～ 24개월。7례ⅡA형환자경보수치료3-6개월골절유합。15례ⅡB형환자라정위치량호，미출현척수손상，기중14례술후3～6개월골성유합，유합솔93.3％；15례ⅡC형、3례엄중이위ⅡB형환자술중미출현추동맥화척수손상，후로식골3～6개월골성융합；복사내치물위치량호，무변형、송동혹단렬；5례반유척수불전손상환자술후척수신경공능균유불동정도개선。 결론 Grauer분형중ⅡA형치상돌골절가이보수치료，ⅡB형(무이위혹경견인복위)의행전로치상돌중공라정내고정술，ⅡC형급엄중이위ⅡB형칙응경후로행환추추추궁근정봉계통내고정식골융합술치료。
Objective To explore the treatment options for fresh Grauer type Ⅱ odontoid fractures and discuss corresponding clinical outcome.Methods The study involved 40 patients with fresh odontoid fractures including seven with type Ⅱ A fractures, 18 with type Ⅱ B and 15 with type ⅡC according to Grauer classification.There were five patients with incomplete cervical cord injuries.Type Ⅱ A fractures were treated by traction of occipital-jaw band or skull for 1-2 weeks and then fixed with head-neck-chest plaster or brace.Type Ⅱ B fractures were treated with anterior odontoid screw system fixation.Fifteen patients with type Ⅱ C fractures and three patients with type Ⅱ B fractures combined with severe fracture displacement were managed with posterior atlantoaxial pedicle screw fixation. Results All the patients were followed up for 6-24 months.Seven patients with type Ⅱ A fractures showed union after fixation with head-neck-chest plaster or brace for 3-6 months.Fifteen patients treated with odontoid screw fixation had good positions of screws, with no injury to the spinal cord, of which 14 patients obtained bone union, with union rate of 93.3％.Eighteen patients (including 15 patients with type Ⅱ C fractures and three with type Ⅱ B fractures combined with severe displacement) managed with atlantoaxial pedicle screw system showed no injury to the vertebral artery and spinal cord.Solid bone fusion was achieved.in 31 patients after 3 to 6 months.The X-ray and SCT scans verified proper fixation of the screws, with no deformation, loosening or breakage of the screws.Five patients with incomplete cervical cord injuries obtained neural function recovery at various degrees after surgery. Conclusions Conservative treatment cau be alternative to type ⅡA fractures.Anterior odontoid hollow screw fixation is better for type ⅡB fractures (non-displaced or reducible) and has advantages of minor trauma, fast postoperative recovery and high union rate.However, posterior atlantoaxial pedicle screw system fixation and fusion is suitable to type Ⅱ C and ⅡB fractures with severe displacement and has the advantages of stable three-dimension fixation, direct screw placement, intraoperative reduction, short-segment fixation and high fusion rate.