Jeanneret B, Magerl F
Klinik für Orthopädische Chirurgie, Kantonsspital, St. Gallen, Switzerland.
J Spinal Disord. 1992 Dec;5(4):464-75. doi: 10.1097/00002517-199212000-00012.
Odontoid fractures, especially unstable type II fractures have a poor prognosis in respect to healing. Therefore, operative stabilization (posterior fusion C1/2 or anterior screw fixation) has been suggested for the treatment of unstable type II and for some unstable type III fractures. Compared to posterior fusion C1/2, anterior screw fixation has proven to be effective; it has the advantage of leaving the motion segment C1/2 intact, therefore preserving at least some C1/2 rotation. However, in some instances, this method of stabilization is not indicated. In these cases, posterior fusion C1/2 is the treatment of choice. Primary posterior fusion C1/2 is indicated in (a) odontoid fracture associated with comminution of one or both atlanto-axial joints; (b) fracture of the odontoid associated with an unstable Jefferson fracture; (c) unstable type III odontoid fracture, when immobilization in a halo jacket or plaster cast is not suitable, as in elderly people or polytraumatized patients; (d) atypical type II fractures (comminuted or with oblique fracture in the frontal plane); (e) irreducible fracture dislocation C1/2, e.g., several-weeks-old fracture; (f) unstable type II or shallow and unstable type III odontoid fracture, when marked thoracic kyphosis is associated with limited extension of the cervical spine; (g) unstable type II or shallow type III odontoid fracture in elderly people with degenerative narrow spinal canal; (h) pathologic fracture of the odontoid. In all these instances, posterior fusion C1/2 is the treatment of choice. We prefer the transarticular screw fixation technique. Compared to other posterior fusion techniques, it has the advantage of increased stability and allows effective stabilization of C1/2 in a reduced position as well as immediate ambulation with minimal head support. This technique can also be performed when the posterior arch of the atlas is fractured or absent. Our experience of 12 acute odontoid fractures, managed by this technique, is presented. At follow-up, all C1/2 fusions were united in reduced position.
齿突骨折，尤其是不稳定的Ⅱ型骨折，愈合预后较差。因此，已建议采用手术稳定治疗（C1/2后路融合或前路螺钉固定）不稳定的Ⅱ型骨折以及部分不稳定的Ⅲ型骨折。与C1/2后路融合相比，前路螺钉固定已被证明是有效的；它的优点是使C1/2运动节段保持完整，因此至少保留了一些C1/2的旋转功能。然而，在某些情况下，这种稳定方法并不适用。在这些情况下，C1/2后路融合是首选治疗方法。C1/2一期后路融合适用于：（a）伴有一侧或双侧寰枢关节粉碎性骨折的齿突骨折；（b）与不稳定的Jefferson骨折相关的齿突骨折；（c）不稳定的Ⅲ型齿突骨折，当不适用于头环背心或石膏固定时，如老年人或多发伤患者；（d）非典型Ⅱ型骨折（粉碎性或额状面斜形骨折）；（e）不可复位的C1/2骨折脱位，如数周龄的骨折；（f）伴有明显胸椎后凸且颈椎伸展受限的不稳定Ⅱ型或浅而不稳定的Ⅲ型齿突骨折；（g）患有退行性椎管狭窄的老年人的不稳定Ⅱ型或浅Ⅲ型齿突骨折；（h）齿突病理性骨折。在所有这些情况下，C1/2后路融合是首选治疗方法。我们更倾向于经关节螺钉固定技术。与其他后路融合技术相比，它具有稳定性增加的优点，并且能够在复位位置有效稳定C1/2，以及在最小头部支撑下立即行走。当寰椎后弓骨折或缺失时也可进行此技术。本文介绍了我们采用该技术治疗12例急性齿突骨折的经验。随访时，所有C1/2融合均在复位位置愈合。
