摘要
目的 评价几种手术方法治疗齿状突骨折合并寰枢椎脱位的临床应用效果。方法 回顾性分析了采用手术治疗的 2 4例齿状突骨折合并寰枢椎脱位的病例 ,其中齿状突Ⅱ型 10例 ,Ⅲ型 14例 ,采用前路齿状突加压螺钉内固定 8例 ;椎板间ATLAS钛缆系统固定或Apofix椎板夹固定、后路寰枢椎融合 10例 ;改良后路Magerl联合Gallie内固定、寰枢椎融合 6例。结果 术后随访 3～ 30个月 ,颈椎活动度的保持以齿状突螺钉固定最佳 ,后路椎板间固定和Magerl联合Gallie内固定病例颈椎旋转度丧失较多 ;7例出现不完全性四肢瘫患者的术前脊髓功能Frankel分级C级 4例、D级 3例 ,术后D级 5例、E级 2例 ,无一例发生脊髓损伤加重及术后感染 ;术后 3个月X线片显示所有内置物无松动、脱落及断裂 ,无复位丢失。结论 前路齿状突螺钉技术是治疗齿状突骨折合并寰枢椎脱位的首选 ,只有在齿状突螺钉禁忌时才考虑采用寰枢椎融合 ;坚强内固定是后路寰枢椎融合的有力保障 ,改良Magerl联合Gallie三点内固定具有较好的生物力学性能 ,是实施后路寰枢椎融合的理想内固定技术。
Objective To evaluate the clinical outcomes in the treatment of odontoid fracture with atlantoaxial dislocation by kinds of operations.Methods Retrospective analysis 24 cases,who were treated by internal fixation.Among them,8 cases were treated by fixation of anterior odontoid screw;10 cases by fixation of ATLAS titan system or Apofix system and fused in atlantoaxial;6 cases by combined Magerl with Gallie and fused in atlantoaxial.Results Followed up by 3～30 months,all range of motions maintained in the group of anterior odontoid screw;the rotation functions lost more in groups of posterior fixation.In 7 cases of incomplete quadriplegia,the spinal function of Frankel C was 4 cases,Frankel D 3 cases before operation,after operation,Frankel D was 5 cases,Frankel E 2 casess.No case got worse and infection;3 months later,the X-ray show none of the internal fixation device loosened、splited and broken,no case lost its reduction.Conclusion The technique of anterior odontoid screw should be the best method in treating odontoid fracture with atlantoaxial dislocation;only in the contraindication of odontoid screw fixation,the atlantoaxial fusion should be utilized.Firmly internal fixation is the premise of posterior atlantoaxial fusion,combined modifid Magerl with Gallie possessed better biomechanical function,it is an ideal technique used in poeterior atlantoaxial fusion.
出处
《中国骨与关节损伤杂志》
2005年第2期79-81,共3页
Chinese Journal of Bone and Joint Injury
关键词
齿状突骨折
寰枢椎脱位
手术治疗
齿状突螺钉
后路固定
Odontoid fracture
Atlantoaxial dislocation
Odontid screw
Posterior fixation
Atlantoaxial fusion
