Morgan Jeremy P, Asfora Wilson T
Sanford Research, Sioux Falls, USA.
S D Med. 2013 May;66(5):183, 185-7, 189.
Anterior screw fixation of the odontoid is contraindicated in remote type II fractures. The alternative surgical treatment consists of a posterior C1 to C2 or an occiput to C3 fusion, which is met with much resistance by patients as this option limits head motion, especially rotational movement. Furthermore, elderly patients may not be medically fit to undergo surgery of this magnitude. This report presents two remote type II odontoid fractures in elderly patients (67 and 73 years of age) who were successfully treated by means of anterior screw fixation of the odontoid along with an injection of recombinant human bone morphogenic protein (rhBMP-2) (Medtronic Inc.) into the fracture line with infiltration of the fibrous union tissue and adjacent anterior longitudinal ligament. To our knowledge, this is the first documented report of solid fusion of remote type II odontoid fracture treated with rhBMP-2 and anterior screw fixation. The authors believe that this technique may be a viable alternative for the treatment of failed odontoid fractures older than six months.
陈旧性Ⅱ型齿状突骨折禁忌采用前路螺钉固定。替代的手术治疗方法包括后路C1至C2或枕骨至C3融合术，但这种选择会受到患者的很大抵触，因为该方法会限制头部活动，尤其是旋转运动。此外，老年患者可能在医学上不适合进行如此大型的手术。本报告介绍了两名老年患者（分别为67岁和73岁）的陈旧性Ⅱ型齿状突骨折，他们通过齿状突前路螺钉固定术，并向骨折线注射重组人骨形态发生蛋白（rhBMP-2，美敦力公司生产），使其渗透到纤维愈合组织和相邻的前纵韧带，从而获得成功治疗。据我们所知，这是首例关于使用rhBMP-2和前路螺钉固定治疗陈旧性Ⅱ型齿状突骨折实现牢固融合的文献报道。作者认为，该技术可能是治疗超过6个月的陈旧性齿状突骨折失败的一种可行替代方法。
