Zhong Dejun, Lee Guangzhou, Liao Yehui, Wang Qing
Department of Spine Surgery, the Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan Province, China.
Department of Spine Surgery, the Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan Province, China.
World Neurosurg. 2017 Oct;106:693-698. doi: 10.1016/j.wneu.2017.06.115. Epub 2017 Jun 21.
To evaluate results and feasibility of primary posterior reduction and fixation without fusion using C1-C2 screw-rod system for odontoid fractures.
This study comprised a consecutive series of 46 patients with odontoid fractures. Posterior reduction and fixation without fusion using the C1-C2 screw-rod system was performed, and instrumentation was not removed. Radiologic outcomes were assessed on follow-up computed tomography or plain radiographs. Visual analog scale of neck pain, American Spinal Injury Association impairment scale, patient satisfaction, neck disability index, and range of motion of flexion extension and rotation of the cervical spine were recorded and analyzed.
Mean follow-up time was 4.1 years (range, 12 months to 8 years). Radiographic evaluation indicated solid fusion of odontoid fractures in all cases and no implant failures. No patient reported severe neck pain at follow-up. Neurologicl evaluation showed there was 1- to 2-grade improvement in patients with neurologic deficit. Of patients, 31 reported acceptable outcomes, and 15 reported good outcomes. Range of motion of rotation of the cervical spine and neck disability index score gradually improved significantly during 1 year of follow-up with no obvious change after that. Rate of neck disability index score improvement was 85%.
Posterior reduction and fixation without fusion can be successfully performed for healing of odontoid fractures with acceptable results and minimal morbidity.
评估使用C1-C2螺钉棒系统对齿状突骨折进行一期后路复位及固定（不融合）的结果及可行性。
本研究纳入了连续的46例齿状突骨折患者。采用C1-C2螺钉棒系统进行后路复位及固定（不融合），且内固定物未取出。通过随访计算机断层扫描或X线平片评估影像学结果。记录并分析颈部疼痛视觉模拟量表、美国脊髓损伤协会损伤量表、患者满意度、颈部功能障碍指数以及颈椎屈伸和旋转活动度。
平均随访时间为4.1年（范围为12个月至8年）。影像学评估显示所有病例齿状突骨折均实现牢固融合，且无内固定失败情况。随访时无患者报告有严重颈部疼痛。神经学评估显示神经功能缺损患者有1至2级改善。31例患者报告结果可接受，15例患者报告结果良好。颈椎旋转活动度和颈部功能障碍指数评分在随访1年内逐渐显著改善，之后无明显变化。颈部功能障碍指数评分改善率为85%。
后路复位及固定（不融合）可成功用于齿状突骨折的愈合，结果可接受且并发症最少。
