Li Fangcai, Chen Qixin, Xu Kan
Department of Orthopedics, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Spine (Phila Pa 1976). 2008 Sep 1;33(19):E693-8. doi: 10.1097/BRS.0b013e31817c4ecf.
A retrospective study.
To investigate the treatment of odontoid fractures combined with lower cervical spinal injury.
Odontoid fractures combined with a lower cervical spinal injury are rarely reported in the literature and their incidence and characteristics are not well known.
Seventy-six patients with type II shallow type III odontoid fractures were studied retrospectively. Nine odontoid fractures were found combined with lower cervical spinal injuries; the mean age of patients was 56.8 years. For lower cervical spinal injuries, dislocation was found in 4 patients and disruption of the disc and ligament was found in 5 patients. All patients received surgical management for the odontoid fracture and lower cervical spinal injury in the same operative session. Surgical priority was decided based on neurologic complications, segmental instability, and reducibility of the luxated lower cervical spine. For 3 quadriparetic patients, surgical priority was given to their spinal injuries. For the other 6 patients without neurologic deficits, surgical priority was given to the odontoid fractures in 5 patients because of successful reduction of the dislocation or nondislocation in the lower cervical spine; surgical priority was given to an irreducible lower cervical spine dislocation in the remaining patient.
After an average follow-up period of 18 months, there were no complications and all patients showed fusion both in the odontoid fracture and the lower cervical spinal injury. Three patients with a neurologic deficit improved by 1 or 2 grades on the ASIA scale.
In this series, 9 of 76 (12%) of patients with odontoid fractures also had a lower cervical spinal injury. Surgical stabilization was the choice of treatment as it facilitated early rehabilitation and reduced complications. We propose a new algorithm for treatment according to neurologic complications, segmental instability, and reducibility of the luxated lower cervical spine.
一项回顾性研究。
探讨齿状突骨折合并下颈椎脊髓损伤的治疗方法。
齿状突骨折合并下颈椎脊髓损伤在文献中报道较少，其发病率和特点尚不明确。
回顾性研究76例Ⅱ型浅Ⅲ型齿状突骨折患者。发现9例齿状突骨折合并下颈椎脊髓损伤；患者平均年龄56.8岁。下颈椎脊髓损伤患者中，4例出现脱位，5例出现椎间盘及韧带损伤。所有患者均在同一手术中对齿状突骨折和下颈椎脊髓损伤进行手术治疗。根据神经并发症、节段性不稳定以及脱位的下颈椎的可复性确定手术优先级。对于3例四肢瘫患者，优先处理其脊髓损伤。对于另外6例无神经功能缺损的患者，5例因下颈椎脱位或非脱位成功复位而优先处理齿状突骨折；其余1例患者因下颈椎脱位不可复位而优先处理。
平均随访18个月后，无并发症发生，所有患者的齿状突骨折和下颈椎脊髓损伤均实现融合。3例有神经功能缺损的患者在ASIA量表上改善了1或2级。
在本系列研究中，76例齿状突骨折患者中有9例（12%）同时合并下颈椎脊髓损伤。手术稳定是治疗的选择，因为它有助于早期康复并减少并发症。我们根据神经并发症、节段性不稳定以及脱位的下颈椎的可复性提出了一种新的治疗方案。
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