CAJ | 학술논문

目的探讨齿状突骨折合并寰枢椎不稳的手术方式选择及疗效. 方法对2002年1月至2011年12月收治的54例齿状突骨折合并寰枢椎不稳患者的临床资料进行回顾性分析,男39例,女15例；年龄18 ～55岁,平均36岁；陈旧性齿状突骨折5例,新鲜齿状突骨折49例；齿状突骨折按Anderson-D'Alonzon分型:Ⅱ型30例,Ⅲ型24例；合并寰椎前脱位12例,寰椎后脱位12例,无明显脱位30例；术前神经功能按美国脊髓损伤协会(ASIA)分级:B级2例,C级5例,D级16例,E级31例.其中30例患者行前路齿状突空心螺钉内固定术(A组),8例患者行前路经寰枢关节螺钉内固定术(B组),16例患者行后路寰枢椎椎弓根螺钉内固定术(C组). 结果术中无椎动脉、脊髓损伤发生,术后寰椎脱位患者均获得良好复位.所有患者术后获6～24个月(平均16个月)随访.A组2例患者术后6个月复查示骨折不愈合,A组其他患者和B、C组所有患者均在术后3～4个月骨折愈合.无螺钉松动、断钉、退钉发生.所有患者术后6个月神经功能按ASIA分级:C级2例,D级6例,E级46例. 结论上述三种手术方式均是治疗齿状突骨折合并寰枢椎不稳的有效方法.临床根据患者具体病情首选前路齿状突空心螺钉内固定治疗,此方法不合适时可考虑行前路经寰枢关节螺钉内固定术或后路寰枢椎椎弓根螺钉内固定术等寰枢椎融合术.
목적 탐토치상돌골절합병환추추불은적수술방식선택급료효. 방법 대2002년1월지2011년12월수치적54례치상돌골절합병환추추불은환자적림상자료진행회고성분석,남39례,녀15례；년령18 ～55세,평균36세；진구성치상돌골절5례,신선치상돌골절49례；치상돌골절안Anderson-D'Alonzon분형:Ⅱ형30례,Ⅲ형24례；합병환추전탈위12례,환추후탈위12례,무명현탈위30례；술전신경공능안미국척수손상협회(ASIA)분급:B급2례,C급5례,D급16례,E급31례.기중30례환자행전로치상돌공심라정내고정술(A조),8례환자행전로경환추관절라정내고정술(B조),16례환자행후로환추추추궁근라정내고정술(C조). 결과 술중무추동맥、척수손상발생,술후환추탈위환자균획득량호복위.소유환자술후획6～24개월(평균16개월)수방.A조2례환자술후6개월복사시골절불유합,A조기타환자화B、C조소유환자균재술후3～4개월골절유합.무라정송동、단정、퇴정발생.소유환자술후6개월신경공능안ASIA분급:C급2례,D급6례,E급46례. 결론 상술삼충수술방식균시치료치상돌골절합병환추추불은적유효방법.림상근거환자구체병정수선전로치상돌공심라정내고정치료,차방법불합괄시가고필행전로경환추관절라정내고정술혹후로환추추추궁근라정내고정술등환추추융합술.
Objective To investigate 3 operative treatments and their clinical outcomes for instability of atlantoaxial complex combined with odontoid fracture.Methods From January 2002 to December 2011,54 cases of instability of atlantoaxial complex combined with odontoid fracture were treated surgically in our department.They were 39 males and 15 females,with a mean age of 36 years (range,18 to 55 years).Of them,5 fractures were obsolete and 19 fresh.According to the classification of Anderson-D'Alonzon,30 cases were type Ⅱ and 24 type Ⅲ,12 cases had atlas anterior dislocation,12 atlas posterior dislocation and 30 no obvious dislocation.The preoperative neural function by the American Spinal Injury Association (ASIA) system:grade B in 2,grade C in 5,grade D in 16 and grade E in 31 cases.According to the fracture type and individual status,30 patients underwent internal fixation with anterior odontoid cannulated screws (group A),8 patients had internal fixation with anterior C1-C2 transarticular screws (group B)and 16 patients received internal fixation with posterior C1-C2 screw-rods (group C).Results No intraoperative injury to the vertebral artery or the spinal cord occurred.The patients with atlas dislocation obtained fine reduction post-operation.The mean time of follow-up was 16 months (range,6 to 24 months).All the patients got bony union 3 to 4 months after operation except for the 2 cases in group A who showed nonunion 6 months after operation without clinical symptoms.No instrument failure was found at the final follow-up.According to the ASIA grading 6 months after operation,2 cases were rated as grade C,6 as grade D and 46 as grade E.Conclusions The above 3 surgical treatments are all effective for instability of atlantoaxial complex combined with odontoid fracture.The internal fixation with anterior odontoid cannulated screws should be the first option.Only when it is inappropriate,fixation with anterior C1-C2 transarticular screws and fixation with posterior C1-C2 screw-rods can be taken into consideration.