Department of Orthopaedic Surgery, The Third Military Medical University, Chongqing, People's Republic of China.
Spine (Phila Pa 1976). 2011 Aug 15;36(18):1459-63. doi: 10.1097/BRS.0b013e3181f46ee8.
Prospective controlled study of the clinical and radiographic results of a group of 42 cases having undergone anterior screw fixation for type II and rostal type III odontoid fractures.
The objective of this study is to determine the safety and efficacy of percutaneous anterior screw fixation as an alternative new technique in the management of type II and rostal type III odontoid fractures.
Minimally invasive spinal techniques have only recently been developed. However, clinical and radiographic outcome of minimally invasive anterior screw fixation for odontoid fractures has been evaluated in very few studies. There have been no prospective clinical reports published on the comparison of percutaneous anterior screw fixation for type II and "shallow" type III odontoid fractures or a traditional open manner.
Forty-two patients, 26 men and 16 women, with an average age of 47.1 years (32-65) were prospectively evaluated. All patients underwent percutaneous anterior screw fixation(n = 19) or open screw fixation (n = 23). The following data were compared between the two groups: operative time, blood loss, radiograph exposure time, the clinical and radiographic results, and complications. Radiologic examination of the cervical spine with plain radiographs was performed at 3, 6, and 12 months after surgery.
In comparison with open fixation group, percutaneous fixation group had significantly less operating time and less blood loss. The radiation time and clinical outcome were basically identical in two groups. Radiographic evaluation showed satisfactory bony union and no evidence of abnormal movement at the fracture site in both percutaneous fixation group (18 of 19 cases) and open fixation group (22 of 23 cases). Two cases of postoperative dysphagia occurred in open screw fixation group.
Percutaneous anterior screw fixation is a safe and reliable procedure for treatment of type II and rostral type III odontoid fractures with potential advantages.
前瞻性对照研究了 42 例Ⅱ型和前颅底型齿状突骨折患者行前路螺钉固定的临床和影像学结果。
本研究旨在确定经皮前路螺钉固定作为Ⅱ型和前颅底型齿状突骨折治疗的一种新的微创技术的安全性和有效性。
微创脊柱技术最近才发展起来。然而，经皮前路螺钉固定治疗齿状突骨折的临床和影像学结果仅在少数研究中进行了评估。对于经皮前路螺钉固定Ⅱ型和“浅”Ⅲ型齿状突骨折或传统开放方式的比较，尚未有前瞻性临床报告发表。
42 例患者，男 26 例，女 16 例，平均年龄 47.1 岁（32-65）。所有患者均行前路经皮螺钉固定（n=19）或切开螺钉固定（n=23）。比较两组患者的手术时间、出血量、X 线曝光时间、临床和影像学结果及并发症。术后 3、6、12 个月对颈椎进行颈椎平片检查。
与切开固定组相比，经皮固定组的手术时间和出血量明显减少。两组的辐射时间和临床结果基本相同。影像学评估显示，经皮固定组（19 例中的 18 例）和切开固定组（23 例中的 22 例）均有满意的骨愈合，骨折部位无异常活动。切开螺钉固定组术后有 2 例出现吞咽困难。
经皮前路螺钉固定是治疗Ⅱ型和前颅底型齿状突骨折的一种安全可靠的方法，具有潜在的优势。
