AOSF技术治疗Ⅱ型及浅Ⅲ型齿状突骨折疗效分析.docVIP

AOSF技术治疗Ⅱ型及浅Ⅲ型齿状突骨折疗效分析 　 作者：胡勇，徐荣明，马维虎，杨述华，何贤峰，何宇 【摘要】 目的 探讨前路齿状突螺钉内固定技术治疗Ⅱ型和浅Ⅲ型齿状突骨折安全性和临床疗效。方法 应用前路齿状突螺钉内固定技术治疗齿状突骨折32 例，男23 例，女9 例。年龄19～78 岁，平均(52.6±3.2) 岁。按AndersonD′Alonzo分型，Ⅱ型20 例，浅Ⅲ型12 例。均采用1枚空心加压螺钉固定。通过上颈椎正侧位及张口位X线片和CT进行评价。结果 32 例均获得随访，随访时间6～28月，平均18个月。除2 例Ⅱ型骨折未愈合外，其余平均愈合时间6个月。无螺钉断裂、移位及神经损伤等并发症。临床症状完全消失26 例，3 例遗留颈部僵硬感，但临床检查无活动受限，2 例合并颅脑损伤者残留部分头痛、头晕。结论 前路齿状突螺钉内固定技术是治疗Ⅱ型和浅Ⅲ型齿状突骨折有效和安全的方法，能最大限度地保留寰枢椎的生理活动功能。 【关键词】 齿状突骨折；上颈椎；螺钉；枢椎；固定 The Analysis of Curative Effect of Anterior Odontoid Screw Fixation for Treating Type Ⅱ and Shallow Type Ⅲ Odontoid Fractures Abstract：Objective To investigate clinical effect and safety of anterior odontoid screw fixation(AOSF) for treating type Ⅱ and shallow type Ⅲ odontoid fractures.Methods 32 cases of type Ⅱ (20 cases) and shallow type Ⅲ (12 cases) odontoid fractures were treated by anterior odontoid screw fixation.Male 23 cases，female 9 cases，mean age (52.6±3.2) years，range：from 19 to 78 years.All cases use singlescrew fixation.Imaging studies were used to analyze the surgeryrelated results in these patients.Results All patients were followedup for an average of 18 months (range 6～28 months).Bony fusion was average obtained for 3 months except for 2 cases which are type II odontoid fractures.The guide pin was broken in one case.There were no loosening or break of the screw and nerve injury.The clinical symptom and signs had completely disappeared in 26 cases.There was cervical stiffness in 3 cases，There was residual headache and dizzy in 2 cases.Conclusion AOSF techniques is an effective and safe method for treating type Ⅱ and shallow type Ⅲ odontoid fractures.and it can preserve normal C12 motion. Key words：odontoid fractures；upper cervicle spine；screw；axial；fixation 齿状突骨折是一类特殊的上颈椎骨折，占成人颈椎骨折的9％～15％［1］，病死率为5％～10％［2］。这一数据仍可能有误差，因为有些患者在入院前已死于脑干或脊髓损伤。齿状突骨折早期曾采用上颈椎融合治疗，但结果是以牺牲寰枢椎的运动功能来换取寰枢椎的稳定［3］。前路齿状突螺钉内固定(anterior odontoid screw fixation，AOSF)既能即刻稳定齿状突骨折，又能保留寰枢关节的正常旋转活动，目前被认为是治疗齿状突骨折较理想的方法［4］。我科自2003年6月至2006年6月，采用AOSF技