颈前路加压螺钉内固定治疗齿状突骨折.docVIP

颈前路加压螺钉内固定治疗齿状突骨折 作者：贾卫斗 白桂有 郑铁钢 许英杰 云得才 史威 【摘要】 目的：探讨颈前路加压螺钉内固定治疗成人齿状突骨折的临床疗效。方法：对15例成人新鲜齿状突Ⅱ型、浅Ⅲ型骨折，在C形臂X线监视下，行前路加压螺钉内固定治疗，分析其治疗效果及并发症。结果：随访8个月～5年4个月，平均11个月，X线片示骨折均获骨性愈合，无明显颈部运动受限，无螺钉断裂、移位及神经损伤等并发症，13例临床症状完全消失，2例因合并颅脑损伤者遗留头痛、头晕。结论：颈前路加压螺钉内固定技术是治疗Ⅱ型、浅Ⅲ型齿状突骨折最佳选择，具有损伤小、并发症少、固定牢靠及愈合率高等优点，正确的选择适应征、充分的术前准备和精细的手术操作是治疗成功的关键，是一种值得推广的手术方法。 【关键词】 枢椎；齿状回；骨折；加压螺钉；内固定器 【ABSTRACT】 Objective:To study Clinical efficacy on internal fixation of cervical anterior compression screw for odontoid fracture.Methods:15 adult patients with the fresh type II and superficial III odontoid fracture were treated with internal fixation of anterior compression screw under the monitor of X-ray,its therapeutic efficacy and complication were analyzed.Results:During a follow up of 8-64months,mean 11 months,all the fractures required bony healing in X-ray sheet without complications such as neck movement limited,screw broken,screw displaced and nerve injured,clinical symptom completely obliterated in 13 of all,part of headache and dizziness leaved in 2 of all because of head injury.Conclusion:The internal fixation of cervical anterior compression screw is the best treatment for the fresh type II and superficial III odontoid fracture ,with the advantages of little lesion,little complication,firm fixation and high healing.Right symptom selection,sufficient preoperative preparation and refined operative procedure are key points for the operation,and this operation method is worth extending. 【KEY WORDS】 Axis,Dentate Gyrus,Bone Fractures,Compression Screw,Internal Fixators 成人齿状突骨折在上颈椎损伤中较为常见，齿状突Ⅱ型、浅Ⅲ型骨折是一种不稳定性骨折，过去临床治疗中多以不加区别的保守治疗为主，因而不愈合率极高。近年来，随着影像学、手术技术的提高及内固定材料发展，对于成人齿状突Ⅱ型、浅Ⅲ型骨折，多采用手术治疗方法。我院自2000.5～2007.6月采用颈前路加压螺钉内固定治疗Ⅱ型、浅Ⅲ型齿状突骨折15例，取得满意疗效，现报道如下。 1 资料与方法 1.1 一般资料 本组男11例，女4例;年龄18～54岁，平均38岁;致伤原因：高处坠落伤9例，交通伤6例。合并肢体骨折7例,头部损伤3例,脊髓损伤3例;临床上多表现为上肢乏力、酸痛、麻木;均有颈部活动受限，颈肩部疼痛，严重者表现为颈部僵硬。所以病人均常规拍摄颈椎正侧位、张口位X线片及64排薄层CT三维成像检查，按照Anderson和Alonzn分类，均为新鲜骨折，Ⅱ型齿状突9例，浅Ⅲ型骨折6