摘要
目的：探讨后路悬臂梁支撑线缆牵拉复位固定治疗齿状突骨折并寰枢椎脱位的临床疗效.方法：回顾性分析2008年1月至2013年12月收治的12例齿状突骨折并寰枢椎脱位患者的临床资料,其中男8例,女4例;年龄21～53岁,平均37.2岁.11例为新鲜骨折脱位,1例为陈旧性骨折脱位,均为寰枢椎前脱位.依据Grauer改良的Anderson-D＇Alonzo分型,ⅡA型3例,ⅡB型5例,ⅡC型3例,ⅢA型1例.所有病例行后路悬臂梁支撑线缆牵拉复位固定治疗.术后分别采用JOA评分和ADI测量对神经功能和寰枢椎脱位复位情况进行评估.结果：所有患者获得随访,时间6个月～2年,平均1年3个月.JOA评分术后1周、6个月及末次随访分别为13.2±1.3、13.5±1.4、14.3±1.5,较术前的8.3±1.4明显改善（P＜0.05）.术后X线及CT示寰枢椎前脱位均复位满意,术后1周、6个月及末次随访ADI分别为（2.2±0.4）、（2.4±0.6）、（2.3±0.5）mm,均较术前的（5.8±1.2） mm明显改善（P＜0.05）.内固定螺钉及线缆位置良好,无松动、断裂,寰枢椎后间隙植骨均融合.结论：后路悬臂梁支撑线缆牵拉复位固定治疗齿状突骨折并寰枢椎脱位是一种固定牢固、安全可靠的方法,可获得良好的临床效果.
Objective：To explore the clinical effects of surgical treatment with cable dragged reduction and cantilever beam internal fixation by posterior approach for odontoid fracture associated with atlantoaxial dislocation.Methods：The clinical data of 12 patients with odontoid fracture associated with atlantoaxial dislocation from January 2008 to December 2013 were retrospectively analyzed.There were 8 males and 4 females,ranging in age from 21 to 53 years with an average of 37.2 years.Eleven cases were fresh fracture and 1 case was old fracture,all patients complicated with atlantoaxial anterior dislocation.According to Anderson-D＇Alonzo typing method modified by Grauer,3 cases were type Ⅱ A,5 cases were type Ⅱ B,3 cases were type Ⅱ C,and 1 case was type Ⅲ A.All patients underwent surgical treatment with cable dragged reduction and cantilever beam internal fixation by posterior approach.JOA score and ADI method were respectively used to evaluate the nerve function and reductive condition of atlantoaxial dislocation.Results：All patients were followed up from 6 months to 2 years with an average of 1 year and 3 months.At 1 week,6 months after operation,and final follow-up,JOA scores were 13.2±1.3,13.5± 1.4,14.3± 1.5,respectively,and these data were obviously better than that of preoperative 8.3± 1.4 （P＜0.05）.Postoperative X-rays and CT showed satisfactory reduction of atlantoaxial dislocation.At 1 week,6 months after operation,and final follow-up,ADI were （2.2±0.4）,（2.4±0.6）,（2.3±0.5） mm,respectively,and these data were obviously better than that of preoperative.（5.8±1.2） mm （P＜0.05）.All screws and cables had good location without looseness and breakage,and bone graft got fusion.Conclusion：Surgical treatment with cable dragged reduction and cantilever beam internal fixation by posterior approach for odontoid fracture associated with atlantoaxial dislocation is a good method,with advantage of firm fixation and high safety.It could obtain good clinical effects.
出处
《中国骨伤》
CAS
2016年第10期892-897,共6页
China Journal of Orthopaedics and Traumatology
关键词
齿状突骨折
寰枢椎脱位
悬臂梁
线缆牵拉复位
Odontoid fracture
Atlantoaxial dislocation
Cantilever beam
Cable dragged reduction
