CAJ | 학술논문

目的探讨前路齿状突螺钉偏向置入治疗合并寰椎后脱位的齿状突骨折的疗效. 方法自2002年8月至2011年12月收治合并寰椎后脱位的齿状突骨折患者18例,男10例,女8例;年龄20 ～50岁,平均41岁;均为新鲜齿状突骨折,骨折按照Anderson-D'Alonzo分型:Ⅱ型12例,Ⅲ型6例,术前神经功能按美国脊髓损伤协会(ASIA)分级:C级3例,D级10例,E级5例;术前颅骨牵引均不同程度复位,术中为维持寰椎复位及齿状突骨折断端对位对线将头部固定在前屈靠近胸部位置,由于前屈位时下颌骨阻挡齿状突导针置入,所有患者均偏向置入前路齿状突螺钉. 结果本组患者手术时间1.0～1.5h,术中出血量50 ～100 mL,平均75 mL.术后随访12～18个月(平均15个月),术后3～4个月齿状突骨折均愈合,未见断钉、退钉等情况发生;术后神经功能按ASIA分级评估:有1例患者由C级恢复至E级,1例患者由C级恢复至D级,9例患者由D级恢复至E级,其他患者无明显改变.手术前、后寰椎移位距离[(5.33±1.75) mm vs.(1.83±0.79) mm]比较,差异有统计学意义(t=10.424,P=0.000). 结论在合并寰椎后脱位的齿状突骨折治疗中,偏向置入前路齿状突螺钉疗效确切,可保留寰枢椎旋转功能,为此类损伤的治疗提供了一种新思路.
목적 탐토전로치상돌라정편향치입치료합병환추후탈위적치상돌골절적료효. 방법 자2002년8월지2011년12월수치합병환추후탈위적치상돌골절환자18례,남10례,녀8례;년령20 ～50세,평균41세;균위신선치상돌골절,골절안조Anderson-D'Alonzo분형:Ⅱ형12례,Ⅲ형6례,술전신경공능안미국척수손상협회(ASIA)분급:C급3례,D급10례,E급5례;술전로골견인균불동정도복위,술중위유지환추복위급치상돌골절단단대위대선장두부고정재전굴고근흉부위치,유우전굴위시하합골조당치상돌도침치입,소유환자균편향치입전로치상돌라정. 결과 본조환자수술시간1.0～1.5h,술중출혈량50 ～100 mL,평균75 mL.술후수방12～18개월(평균15개월),술후3～4개월치상돌골절균유합,미견단정、퇴정등정황발생;술후신경공능안ASIA분급평고:유1례환자유C급회복지E급,1례환자유C급회복지D급,9례환자유D급회복지E급,기타환자무명현개변.수술전、후환추이위거리[(5.33±1.75) mm vs.(1.83±0.79) mm]비교,차이유통계학의의(t=10.424,P=0.000). 결론 재합병환추후탈위적치상돌골절치료중,편향치입전로치상돌라정료효학절,가보류환추추선전공능,위차류손상적치료제공료일충신사로.
Objective To investigate deflective placement of anterior odontoid cannulated screw for treatment of odontoid fracture combined with atlantoaxial posterior dislocation.Method From August 2002 to December 2011,18 cases of fresh odontoid fracture combined with atlantoaxial posterior dislocation were treated with deflective placement of anterior odontoid cannulated screw in our hospital.They were 10 males and 8 females,aged from 20 to 50 years (mean,41 years).According to the classification of Anderson-D'Alonzon,12 cases were type Ⅱ and 6 type Ⅲ; according to the classification of American Spinal Injury Association (ASIA),3 cases were grade C,10 grade D and 5 grade E.All patients underwent skull traction pre-operation to reduce dislocation.During the operation,the head was bent close to the chest in order to maintain atlantoaxial restoration and odontoid reduction.Because in this posture the jawbone blocked Kirschner wire and made the placement challenging,the anterior odontoid cannulated screw was deflected in all cases.Results In this series,the operation time ranged from 1.0 to 1.5 hours and the blood loss 50 to 100 mL (mean,75 mL).The mean time of follow-up was 15 months (range,12 to 18 months).All cases got bony union 3 to 4 months postoperation without screw failure.According to the ASIA grading for neural function,one case improved from grade C to grade E,one from grade C to grade D,9 cases from grade D to grade E,and no improvement was noted in the other cases.The difference in atlantoaxial shift distance between preoperation and postoperation was statistically significant (P ＜ 0.05).Conclusion In the treatment of odontoid fracture combined with atlantoaxial posterior dislocation,deflective placement of anterior odontoid cannulated screw may preserve the rotation function of the atlas and axis and lead to positive outcomes.