經皮前路齒狀突和關節突螺釘固定治療老年Ⅱ型齒狀突骨折療效觀察_《中國修復重建外科雜志》

作者：

王建 , 鄭文杰 , 張正豐 , 李長青 , 周躍

第三軍醫大學新橋醫院骨科（重慶，400037）;

關鍵詞：

齒狀突骨折內固定微創外科老年患者

DOI：

10.7507/1002-1892.20130238

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目的探討經皮前路齒狀突和關節突螺釘固定治療老年Ⅱ型齒狀突骨折的療效。方法2009年10月－2012年3月，對5例老年齒狀突骨折患者行經皮前路3枚螺釘固定齒狀突和雙側寰樞椎關節突治療。男4例，女1例；年齡65～74歲，平均69.4歲。均為高處墜落致傷。受傷至手術時間3～12 d，平均6.8 d。齒狀突骨折根據Anderson-D’Alonzo分型方法，均為Ⅱ型；伴寰椎前弓骨折1例。神經功能按Frankel分級，E級4例，D級1例。記錄手術時間、術中出血量、放射線暴露時間和并發癥情況，攝X線片觀察寰樞椎穩定和內植物情況。結果患者均順利完成手術，無轉為開放手術者。手術時間93～114 min，平均103.6 min；術中出血量3～10 mL，平均5.6 mL；放射線暴露時間17～32 s，平均24.2 s。5例均獲得良好寰樞椎復位。術后切口均Ⅰ期愈合。5例均獲隨訪，隨訪時間12～35個月，平均21.4個月。3例術后出現吞咽困難，經對癥處理5 d內癥狀消失。無血管、脊髓神經、氣管、食道損傷及內植物失敗等并發癥發生。復查頸椎X線片示齒狀突骨折均愈合，愈合時間5～10個月，平均7個月；螺釘位置良好、寰樞椎穩定。末次隨訪時5例神經功能正常，Frankel分級均為E級。3例訴頸部不適，活動受限，但不影響日常生活，未作特殊處理；余2 例無不適表現。結論經皮前路螺釘固定齒狀突和雙側關節突安全、有效、微創，可作為老年Ⅱ型齒狀突骨折手術方法之一。

引用本文： 王建,鄭文杰,張正豐,李長青,周躍. 經皮前路齒狀突和關節突螺釘固定治療老年Ⅱ型齒狀突骨折療效觀察. 中國修復重建外科雜志, 2013, 27(9): 1090-1093. doi: 10.7507/1002-1892.20130238 復制

1.	Löhrer L, Raschke MJ, Thiesen D, et al. Current concepts in the treatment of Anderson Type II odontoid fractures in the elderly in Germany, Austria and Switzerland. Injury, 2012, 43(4): 462-469.
2.	Lefranc M, Peltier J, Fichten A, et al. Odontoid process fracture in elderly patients over 70 years: morbidity, handicap, and role of surgical treatment in a retrospective series of 27 cases. Neurochirurgie, 2009, 55(6): 543-550.
3.	Collins I, Min WK. Anterior screw fixation of type II odontoid fractures in the elderly. J Trauma, 2008, 65(5): 1083-1087.
4.	Maak TG, Grauer JN. The contemporary treatment of odontoid injuries. Spine (Phila Pa 1976), 2006, 31(11 Suppl): S53-61.
5.	陸焱, 王建, 鄭文杰, 等. 微創前路經寰樞椎關節突固定融合治療寰樞椎不穩. 中國修復重建外科雜志, 2012, 26(7): 769-772.
6.	Carlson GD, Heller JG, Abitbol JJ, et al. Odontoid fractures//Levine AM, ed. Spine Trauma. Philadelphia: Saunders, 1998: 227-248.
7.	Böhler J. Anterior stabilization for acute fractures and non-unions of the dens. J Bone Joint Surg (Am), 1982, 64(1): 18-27.
8.	Chi YL, Wang XY, Xu HZ, et al. Management of odontoid fractures with percutaneous anterior odontoid screw fixation. Eur Spine J, 2007, 16(8): 1157-1164.
9.	Wang J, Zhou Y, Zhang ZF, et al. Comparison of percutaneous and open anterior screw fixation in the treatment of type II and rostral type III odontoid fractures. Spine (Phila Pa 1976), 2011, 36(18): 1459-1463.
10.	Wu AM, Wang XY, Chi YL, et al. Management of acute combination atlas-axis fractures with percutaneous triple anterior screw fixation in elderly patients. Orthop Traumatol Surg Res, 2012, 98(8): 894-899.
11.	White AP, Hashimoto R, Norvell DC, et al. Morbidity and mortality related to odontoid fracture surgery in the elderly population. Spine (Phila Pa 1976), 2010, 35(9 Suppl): S146-157.
12.	Omeis I, Duggal N, Rubano J, et al. Surgical treatment of C2 fractures in the elderly: a multicenter retrospective analysis. J Spinal Disord Tech, 2009, 22(2): 91-95.
13.	Pal D, Sell P, Grevitt M. Type II odontoid fractures in the elderly: an evidence-based narrative review of management. Eur Spine J, 2011, 20(2): 195-204.
14.	Andersson S, Rodrigues M, Olerud C. Odontoid fractures: high complication rate associated with anterior screw fixation in the elderly. Eur Spine J, 2000, 9(1): 56-59.
15.	Huybregts JG, Jacobs WC, Vleggeert-Lankamp CL. The optimal treatment of type II and III odontoid fractures in the elderly: a systematic review. Eur Spine J, 2013, 22(1): 1-13.
16.	Mayer M, Zenner J, Auffarth A, et al. Efficacy of anterior odontoid screw fixation in the elderly patient: a CT-based biometrical analysis of odontoid fractures. Eur Spine J, 2011, 20(9): 1441-1449.
17.	Osti M, Philipp H, Meusburger B, et al. Analysis of failure following anterior screw fixation of Type II odontoid fractures in geriatric patients. Eur Spine J, 2011, 20(11): 1915-1920.

1. Löhrer L, Raschke MJ, Thiesen D, et al. Current concepts in the treatment of Anderson Type II odontoid fractures in the elderly in Germany, Austria and Switzerland. Injury, 2012, 43(4): 462-469.
2. Lefranc M, Peltier J, Fichten A, et al. Odontoid process fracture in elderly patients over 70 years: morbidity, handicap, and role of surgical treatment in a retrospective series of 27 cases. Neurochirurgie, 2009, 55(6): 543-550.
3. Collins I, Min WK. Anterior screw fixation of type II odontoid fractures in the elderly. J Trauma, 2008, 65(5): 1083-1087.
4. Maak TG, Grauer JN. The contemporary treatment of odontoid injuries. Spine (Phila Pa 1976), 2006, 31(11 Suppl): S53-61.
5. 陸焱, 王建, 鄭文杰, 等. 微創前路經寰樞椎關節突固定融合治療寰樞椎不穩. 中國修復重建外科雜志, 2012, 26(7): 769-772.
6. Carlson GD, Heller JG, Abitbol JJ, et al. Odontoid fractures//Levine AM, ed. Spine Trauma. Philadelphia: Saunders, 1998: 227-248.
7. Böhler J. Anterior stabilization for acute fractures and non-unions of the dens. J Bone Joint Surg (Am), 1982, 64(1): 18-27.
8. Chi YL, Wang XY, Xu HZ, et al. Management of odontoid fractures with percutaneous anterior odontoid screw fixation. Eur Spine J, 2007, 16(8): 1157-1164.
9. Wang J, Zhou Y, Zhang ZF, et al. Comparison of percutaneous and open anterior screw fixation in the treatment of type II and rostral type III odontoid fractures. Spine (Phila Pa 1976), 2011, 36(18): 1459-1463.
10. Wu AM, Wang XY, Chi YL, et al. Management of acute combination atlas-axis fractures with percutaneous triple anterior screw fixation in elderly patients. Orthop Traumatol Surg Res, 2012, 98(8): 894-899.
11. White AP, Hashimoto R, Norvell DC, et al. Morbidity and mortality related to odontoid fracture surgery in the elderly population. Spine (Phila Pa 1976), 2010, 35(9 Suppl): S146-157.
12. Omeis I, Duggal N, Rubano J, et al. Surgical treatment of C2 fractures in the elderly: a multicenter retrospective analysis. J Spinal Disord Tech, 2009, 22(2): 91-95.
13. Pal D, Sell P, Grevitt M. Type II odontoid fractures in the elderly: an evidence-based narrative review of management. Eur Spine J, 2011, 20(2): 195-204.
14. Andersson S, Rodrigues M, Olerud C. Odontoid fractures: high complication rate associated with anterior screw fixation in the elderly. Eur Spine J, 2000, 9(1): 56-59.
15. Huybregts JG, Jacobs WC, Vleggeert-Lankamp CL. The optimal treatment of type II and III odontoid fractures in the elderly: a systematic review. Eur Spine J, 2013, 22(1): 1-13.
16. Mayer M, Zenner J, Auffarth A, et al. Efficacy of anterior odontoid screw fixation in the elderly patient: a CT-based biometrical analysis of odontoid fractures. Eur Spine J, 2011, 20(9): 1441-1449.
17. Osti M, Philipp H, Meusburger B, et al. Analysis of failure following anterior screw fixation of Type II odontoid fractures in geriatric patients. Eur Spine J, 2011, 20(11): 1915-1920.

《中國修復重建外科雜志》

經皮前路齒狀突和關節突螺釘固定治療老年Ⅱ型齒狀突骨折療效觀察

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《中國修復重建外科雜志》

經皮前路齒狀突和關節突螺釘固定治療老年Ⅱ型齒狀突骨折療效觀察

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