CAJ | 학술논문

目的：探讨齿状突骨折经皮微创手术方法的选择。方法：回顾性分析2003年7月～2010年5月因齿状突骨折在我院行微创手术治疗随访1年以上患者113例，按患者骨折的不同特点和接受手术方式的不同分成5组，组1为可复位、非ⅡC型骨折及部分骨折面整齐的陈旧性齿状突骨折患者采用经皮前路齿状突螺钉内固定术，共65例；组2为移位重、陈旧性、ⅡC型骨折或伴有寰椎前弓、后弓骨折者患者采用经皮前路颈1/2关节突螺钉内固定术，共29例；组3为联合寰椎前后弓多发骨折患者采用经皮前路齿状突螺钉联合颈1/2侧方关节螺钉内固定术，共6例；组4为移位重、ⅡC型骨折者患者，均无椎动脉高拱畸形采用经皮后路颈1/2侧方关节螺钉内固定术，共4例；组5为陈旧性骨折伴寰枢椎难复性脱位患者采用经皮显微内窥镜下松解复位植骨内固定术，共9例。记录和分析不同组别患者的骨折愈合情况、疗效和并发症。结果：113例患者术后得到12～67个月的随访，未发现弯钉及断钉现象。组1患者中末次随访7例仍见骨折线，其余患者均骨性愈合；组2中1例术后2个月发现螺钉切割，予以取出螺钉+后路开放手术，6例无植骨患者末次随访影像显示颈椎稳定，其余患者均得到骨性愈合；组3患者均骨性愈合；组4患者1例术后发现轻度前移，予以二期开放后路C1/2植骨钛缆内固定，另1例术后CT示螺钉可疑损伤椎动脉；组5患者均骨性愈合，5例症状基本缓解，3例中度缓解，1例轻度缓解。结论：不同类型齿状突骨折可以选择不同方式的经皮微创上颈椎技术治疗，只要正确选择手术方式，掌握手术适应证，可以取得安全、有效的结果。
목적：탐토치상돌골절경피미창수술방법적선택。방법：회고성분석2003년7월～2010년5월인치상돌골절재아원행미창수술치료수방1년이상환자113례，안환자골절적불동특점화접수수술방식적불동분성5조，조1위가복위、비ⅡC형골절급부분골절면정제적진구성치상돌골절환자채용경피전로치상돌라정내고정술，공65례；조2위이위중、진구성、ⅡC형골절혹반유환추전궁、후궁골절자환자채용경피전로경1/2관절돌라정내고정술，공29례；조3위연합환추전후궁다발골절환자채용경피전로치상돌라정연합경1/2측방관절라정내고정술，공6례；조4위이위중、ⅡC형골절자환자，균무추동맥고공기형채용경피후로경1/2측방관절라정내고정술，공4례；조5위진구성골절반환추추난복성탈위환자채용경피현미내규경하송해복위식골내고정술，공9례。기록화분석불동조별환자적골절유합정황、료효화병발증。결과：113례환자술후득도12～67개월적수방，미발현만정급단정현상。조1환자중말차수방7례잉견골절선，기여환자균골성유합；조2중1례술후2개월발현라정절할，여이취출라정+후로개방수술，6례무식골환자말차수방영상현시경추은정，기여환자균득도골성유합；조3환자균골성유합；조4환자1례술후발현경도전이，여이이기개방후로C1/2식골태람내고정，령1례술후CT시라정가의손상추동맥；조5환자균골성유합，5례증상기본완해，3례중도완해，1례경도완해。결론：불동류형치상돌골절가이선택불동방식적경피미창상경추기술치료，지요정학선택수술방식，장악수술괄응증，가이취득안전、유효적결과。
Objectives: To investigate the strategies of percutaneous minimally invasive surgical techniques for odontoid fractures. Methods: Retrospective analysis of 113 patients with odontoid fractures treated by min-imally invasive percutaneous techniques in our department between July 2003 and May 2010. They were di-vided into 5 groups according to the type of fracture and the operative manner. Group 1: reducible, non-ⅡC type or part of chronic fracture with neat fractured surface treated by percutaneous anterior odontoid screw fixation, 65 cases. Group 2: considerable displacement, chronic or ⅡC fracture, or associated with one arch fracture of atlas treated by percutaneous anterior transarticular screw fixation, 29 cases. Group 3: combinated atlas-axis multiple fractures treated by percutaneous anterior odontoid screw fixation and anterior transarticular screw fixation, 6 cases. Group 4: considerable displacement, or ⅡC fracture without high-riding vertebral artery treated by percutaneous posterior transarticular screw fixation, 4 cases. Group 5: chronic fracture with irreducible atlantoaxial dislocation treated by percutaneous anterior microendoscopic release and transarticular screw fixation, 9 cases. The efficacy of different surgical manners was analyzed and complications were recorded. Results: 113 patients were followed up at least for 12 months (12-67 months), none of bend or breakage of screw. Group 1: the fracture line could be still observed in 7 patients at the last follow-up, the others had bone healing. Group 2: one patient had postoperative screw cutting, and underwent screw removal surgery and posterior fusion, the dynamic radiography showed cervical stability on 6 patients without bone graft, the others achieved bone healing. Group 3: all patients achieved bone healing. Group 4: one patient underwent second surgery of titanium cable fixation, and one patient had suspicious damage of the vertebral artery. Group 5: all patients achieved bone healing, the symptoms of 5 patients had complete relief, 3 patients had moderate relief, and 1 patient had mild relief. Conclusions: The majority of patients with odontoid fractures can be treated by minimally invasive surgical technique, the efficacy and safety can be obtained only by choosing the proper surgical indications for different surgical manners.