CAJ | 학술논문

目的：总结应用前路齿突拉力螺钉或后路寰枢椎植骨融合技术治疗成人新鲜齿突骨折的疗效。方法回顾性分析2009年1月～2012年1月期间收治的46例成人齿突骨折患者，男29例，女17例；年龄19～68岁，平均40．5岁。患者均有不同程度的枕颈部疼痛和活动受限，其中7例患者伴有神经功能障碍，术前日本骨科学会（ Japanese Orthopaedic Association， JOA）评分9～14分，平均12．7分。根据Anderson-D’Alonzo分型，Ⅱ型骨折33例（71．7％），Ⅲ型骨折13例（28．3％）。8例患者有不同程度寰椎前脱位，术前寰齿间距（atlanto-dens interval，ADI）3～7 mm，平均4．3 mm，术前进行颅骨牵引术，均可复位。采用前路齿突拉力螺钉或后路寰枢椎植骨融合术治疗，随访患者临床症状和神经功能改善情况，影像学观察寰枢椎复位和植骨融合情况。结果患者均顺利完成手术，术中均未发生椎动脉和脊髓损伤。共置入25枚齿突螺钉和84枚寰枢椎椎弓根螺钉，术后X线片及三维CT检查显示25枚齿突螺钉位置均较好，3枚寰椎椎弓根螺钉内倾角不够，螺钉部分穿破椎动脉孔内侧壁，椎动脉造影未见椎动脉损伤；1枚寰椎椎弓根螺钉内倾角过大，螺钉部分穿破椎管内侧壁，未出现新的神经损伤症状；其余螺钉位置满意。术后ADI为1～2．5 mm，平均1．6 mm。患者均获随访，随访时间8～36个月，平均23个月，术后6个月随访时神经功能明显改善，JOA评分为14～17分，平均16．2分，平均改善率为89．3％。1例行前路齿突螺钉内固定术的患者齿突骨折端硬化，有明显的骨不连发生，其余患者均在术后6个月获得骨性融合，融合率为97．8％；随访期间未发现螺钉松动、移位、螺钉断裂和寰枢椎再移位、失稳现象。结论选择前路齿突拉力螺钉或后路寰枢椎植骨融合技术治疗成人新鲜齿突骨折，可获得良好的临床效果。目的：總結應用前路齒突拉力螺釘或後路寰樞椎植骨融閤技術治療成人新鮮齒突骨摺的療效。方法迴顧性分析2009年1月～2012年1月期間收治的46例成人齒突骨摺患者，男29例，女17例；年齡19～68歲，平均40．5歲。患者均有不同程度的枕頸部疼痛和活動受限，其中7例患者伴有神經功能障礙，術前日本骨科學會（ Japanese Orthopaedic Association， JOA）評分9～14分，平均12．7分。根據Anderson-D’Alonzo分型，Ⅱ型骨摺33例（71．7％），Ⅲ型骨摺13例（28．3％）。8例患者有不同程度寰椎前脫位，術前寰齒間距（atlanto-dens interval，ADI）3～7 mm，平均4．3 mm，術前進行顱骨牽引術，均可複位。採用前路齒突拉力螺釘或後路寰樞椎植骨融閤術治療，隨訪患者臨床癥狀和神經功能改善情況，影像學觀察寰樞椎複位和植骨融閤情況。結果患者均順利完成手術，術中均未髮生椎動脈和脊髓損傷。共置入25枚齒突螺釘和84枚寰樞椎椎弓根螺釘，術後X線片及三維CT檢查顯示25枚齒突螺釘位置均較好，3枚寰椎椎弓根螺釘內傾角不夠，螺釘部分穿破椎動脈孔內側壁，椎動脈造影未見椎動脈損傷；1枚寰椎椎弓根螺釘內傾角過大，螺釘部分穿破椎管內側壁，未齣現新的神經損傷癥狀；其餘螺釘位置滿意。術後ADI為1～2．5 mm，平均1．6 mm。患者均穫隨訪，隨訪時間8～36箇月，平均23箇月，術後6箇月隨訪時神經功能明顯改善，JOA評分為14～17分，平均16．2分，平均改善率為89．3％。1例行前路齒突螺釘內固定術的患者齒突骨摺耑硬化，有明顯的骨不連髮生，其餘患者均在術後6箇月穫得骨性融閤，融閤率為97．8％；隨訪期間未髮現螺釘鬆動、移位、螺釘斷裂和寰樞椎再移位、失穩現象。結論選擇前路齒突拉力螺釘或後路寰樞椎植骨融閤技術治療成人新鮮齒突骨摺，可穫得良好的臨床效果。
목적：총결응용전로치돌랍력라정혹후로환추추식골융합기술치료성인신선치돌골절적료효。방법회고성분석2009년1월～2012년1월기간수치적46례성인치돌골절환자，남29례，녀17례；년령19～68세，평균40．5세。환자균유불동정도적침경부동통화활동수한，기중7례환자반유신경공능장애，술전일본골과학회（ Japanese Orthopaedic Association， JOA）평분9～14분，평균12．7분。근거Anderson-D’Alonzo분형，Ⅱ형골절33례（71．7％），Ⅲ형골절13례（28．3％）。8례환자유불동정도환추전탈위，술전환치간거（atlanto-dens interval，ADI）3～7 mm，평균4．3 mm，술전진행로골견인술，균가복위。채용전로치돌랍력라정혹후로환추추식골융합술치료，수방환자림상증상화신경공능개선정황，영상학관찰환추추복위화식골융합정황。결과환자균순리완성수술，술중균미발생추동맥화척수손상。공치입25매치돌라정화84매환추추추궁근라정，술후X선편급삼유CT검사현시25매치돌라정위치균교호，3매환추추궁근라정내경각불구，라정부분천파추동맥공내측벽，추동맥조영미견추동맥손상；1매환추추궁근라정내경각과대，라정부분천파추관내측벽，미출현신적신경손상증상；기여라정위치만의。술후ADI위1～2．5 mm，평균1．6 mm。환자균획수방，수방시간8～36개월，평균23개월，술후6개월수방시신경공능명현개선，JOA평분위14～17분，평균16．2분，평균개선솔위89．3％。1례행전로치돌라정내고정술적환자치돌골절단경화，유명현적골불련발생，기여환자균재술후6개월획득골성융합，융합솔위97．8％；수방기간미발현라정송동、이위、라정단렬화환추추재이위、실은현상。결론선택전로치돌랍력라정혹후로환추추식골융합기술치료성인신선치돌골절，가획득량호적림상효과。
Objective To summarize the clinical results of anterior screw fixation and posterior atlantoaxial pedicle screw-rod internal fixation in treatment of adult new odontoid fracture.Methods The clinical and radiographic records of 46 (17 female and 29 male) patients with an average age of 40.5 (19-68) years at the time of injury from January 2009 and January 2012 were retro-spectively analyzed.The preoperative atlanto-dens interval (ADI) was 3-7 mm (average 4.3 mm).The patients had various degrees of occipital neck pain,limited mobility and 7 patients associated with neurological dysfunction.Japanese Orthopaedic Association (JOA) scores before operation were recorded from 9 to 14 (mean, 8.3).Eight patients had anterior atlantoaxial dislocation, and underwent skull traction before operation, All cases were fully reduced.Patients were treated with anterior screw fixation or posterior atlantoaxial pedicle screw-rod internal fixation.All patients were assessed clinically for neurologic recovery, atlantoaxial reduction and bone graft fusion.Results No intraoperative vertebral artery injury and spinal cord injury were noted .A total of 25 lag screws and 84 pedicle screws were inserted , postoperative CT reconstruction showed that 4 screw malposition was noted,3 of which penetra-ted lateral pedicle cortex,1 penetrated medial pedicle cortex,80 screws were sited completely in pedicle.All 46 patients were fol-lowed up for an average of 23 months(range,8-36 months).The postoperative ADI was reduced to 1-2.5 mm (average 1.6 mm). JOA scores after operation were recorded from 14 to 17(mean 16.2).The overall improvement rate was 89.3%on average.Solid bony fusion was achieved in 45 patients at 6 months after operation, but nonunion of the odontoid fracture occurred in 1 case.The rate of fusion was 97.8%, With no loosening, displacement, instability or breakage of the screws.JOA scores before operation were recorded from 4 to 14 (mean, 8.3).Six months after surgery all patients were substantially improved with C degree in 3 cases, D degree in 10 cases and E degree in 8 cases.JOA scores after operation were recorded from 10 to 17 (mean, 14.6).The overall improvement rate was 89.3%on average.The postoperative ADI was reduced from 2 mm to 4 mm (average 2.8 mm).Postoperative cervical spine MRI showed that the sagittal cervical spine alignment was restored ,cerebral spinal fluid line was clear in the odontoid process area and no spinal cord compression was found .Conclusion Good clinical results can be achieved by the anterior screw fixation and posterior atlantoaxial pedicle screw-rod internal fixation.