CAJ | 학술논문

目的：分析寰枢椎后路切开复位内固定术治疗陈旧性齿突骨折伴C1，2不稳的临床疗效。方法2008年5月～2012年5月，对32例陈旧性齿突骨折伴C1，2不稳的患者进行寰枢椎后路切开复位内固定术。根据Anderson-D’ Alonzo分型，其中Ⅱ型23例，Ⅲ型9例。从受伤开始到手术治疗时间为6个月～3年，平均19个月。结果所有患者均行寰枢椎后路切开复位内固定术，术中未伤及椎动脉和脊髓。平均手术时间100 min；术中平均出血量290 mL。患者术后平均随访18个月。在术后8个月随访时，患者骨折端均获得骨性融合，随访中未出现螺钉松动、断钉、移位等情况。寰齿前间距由术前7．5 mm缩小至术后2．8 mm （P＜0．05）。日本骨科学会（Japanese Orthopaedic Association， JOA）评分由术前12．5±2．2改善至术后15．4±1．4（ P＜0．05）。在末次随访中，3例患者Frankel分级从D级改善为E级。结论寰枢椎后路切开复位内固定术治疗陈旧性齿突骨折合并C1，2不稳是一种安全有效的方法。
목적：분석환추추후로절개복위내고정술치료진구성치돌골절반C1，2불은적림상료효。방법2008년5월～2012년5월，대32례진구성치돌골절반C1，2불은적환자진행환추추후로절개복위내고정술。근거Anderson-D’ Alonzo분형，기중Ⅱ형23례，Ⅲ형9례。종수상개시도수술치료시간위6개월～3년，평균19개월。결과소유환자균행환추추후로절개복위내고정술，술중미상급추동맥화척수。평균수술시간100 min；술중평균출혈량290 mL。환자술후평균수방18개월。재술후8개월수방시，환자골절단균획득골성융합，수방중미출현라정송동、단정、이위등정황。환치전간거유술전7．5 mm축소지술후2．8 mm （P＜0．05）。일본골과학회（Japanese Orthopaedic Association， JOA）평분유술전12．5±2．2개선지술후15．4±1．4（ P＜0．05）。재말차수방중，3례환자Frankel분급종D급개선위E급。결론환추추후로절개복위내고정술치료진구성치돌골절합병C1，2불은시일충안전유효적방법。
Objective To analyze the clinical results of atlantoaxial posterior open reduction and internal fixation for old odontoid fracture with C1,2 instability.Methods From May 2008 to May 2012, 32 patients with old odontoid fractures com-bined with C1,2 instability were treated with atlantoaxial posterior open reduction and internal fixation .By the Anderson-D’ Alonzo classification ,there were 23 cases of typeⅡand 9 cases of type Ⅲ.The duration from injury to operation averaged 19 months, ranging from 6 months to 3 years.Results All patients were performed atlantoaxial posterior open reduction and internal fixation, no intraoperative vertebral artery injury and spinal cord injury occurred .The average operative time was 100 minand the average blood loss was 290 mL.Patients were followed up for an average of 32 months, all the patients achieved bone fusion at 6 months postoperation ,and no loosening ,breakage or displacement of the screws was found in the follow-up.The atlanto-dens interval(ADI)was decreased from 7.5 mm preoperative to 2.8 mm postopertive(P<0.05).The Japanese Ortho-paedic Association( JOA) score was improved from 12.5 ±2.2 preoperative to 15.4 ±1.4 postoperative (P<0.05).At the final follow-up, according to the Frankel classification ,3 patients had improved from grade D to grade E .Conclusion Atlan-toaxial posterior open reduction and internal fixation was an safe and effective method for old odontoid fracture with C 1,2 insta-bility.