Komadina Radko, Brilej Drago, Kosanović Milos, Vlaović Miodrag
Department of Traumatology, General and Teaching Hospital Celje, Oblakova 5, 3000 Celje, Slovenia.
Arch Orthop Trauma Surg. 2003 Apr;123(2-3):64-7. doi: 10.1007/s00402-003-0473-4. Epub 2003 Mar 20.
The treatment of odontoid fractures remains controversial. The late results of 14 patients with Anderson D'Alonzo type II and III treated with halo jacket from 1995 to 1999 are presented. The fractures were reduced under image intensifier and stabilized by halo jacket. The immobilization period was 12 weeks. After 1 year, the fracture was roentgenologically consolidated in 12 out of 14 patients (85.7%), and all the patients were without neurological deficit. Nine patients (64.3%) were without subjective complaints, five had a reduced range of motion. Painful motion appeared in four patients (28.6%), and cervical stiffness was noted in five (35.7%). We recommend halo jacket for the treatment of most type II and III odontoid fractures which are unstable or displaced 6 mm and more, except for patients with tetraplegia. Fractures with minimal displacement and without neurological deficit were treated conservatively with rigid collars. In our institution, internal fixation was performed in selected cases. The presence of neurological deficit and the anatomic properties of the fracture site crucially influence the choice of treatment.
齿状突骨折的治疗仍存在争议。本文介绍了1995年至1999年间采用头环背心治疗的14例Anderson D’Alonzo II型和III型患者的远期结果。骨折在影像增强器下复位，并用头环背心固定。固定期为12周。1年后，14例患者中有12例（85.7%）骨折在X线片上愈合，所有患者均无神经功能缺损。9例患者（64.3%）无主观不适，5例活动范围减小。4例患者（28.6%）出现疼痛性活动，5例（35.7%）有颈部僵硬。我们建议，除四肢瘫痪患者外，头环背心可用于治疗大多数不稳定或移位6mm及以上的II型和III型齿状突骨折。移位极小且无神经功能缺损的骨折采用硬领保守治疗。在我们机构，部分病例采用了内固定。神经功能缺损的存在以及骨折部位的解剖特性对治疗方法的选择至关重要。
