Jiang Tao, Yin Hong, Ren Xian-Jun, Chu Tong-Wei, Wang Wei-Dong, Li Chang-Qing
Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, 400037, PR China.
Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, 400037, PR China.
J Orthop Sci. 2017 Sep;22(5):816-821. doi: 10.1016/j.jos.2017.06.007. Epub 2017 Jul 12.
Tear drop fracture of axis represents a very small percentage of injuries of the cervical spine, but there is controversy about the treatment method for tear drop fracture of axis, especially when a large avulsed fragment is significant displacement, which combined with the inferior endplate serious traversed lesion of axis.
To evaluate the clinical outcome of anterior reduction, graft fusion of C2-3 and plate fixation in the management of massive tear drop fracture of axis combining with inferior endplate serious traversed lesion of axis.
There were 7 patients with a massive tear drop fracture of axis combining with inferior endplate serious traversed lesion. The avulsed ratio of inferior endplate of axis was 46.8 ± 13.4%, the average angle of rotation of the avulsed fragment was 30.4 ± 11.7, and the average displacement was 7.7 ± 2.8 mm. The posterior displacement of axis body was observed with three patients. All patients underwent anterior reduction, graft fusion of C2-3 and plate fixation with high anterior cervical retropharyngeal approach. The follow-up ranges from 2 years to 5 years.
In all cases, tear drop fracture was reduced completely, avulsed fragment got bony healing, and bone graft achieved bony fusion at C2-3. There were no local angle deformity and rotated deformity in all patients, and there were normal physiological lordosis and good stabilization of upper cervical spine. The neurological function of one patient with American Spine Injury Association (ASIA) impairment scale type D was improved to type E postoperatively. Six patients without neurological lesion had no neurological syndrome after operation.
Anterior surgical procedures would be an effective treatment of massive tear drop fracture of axis combining with inferior endplate serious traversed lesion. Complete reduction, sufficient stabilization and normal physiological lordosis of upper cervical spine could be achieved postoperatively.
枢椎泪滴形骨折在颈椎损伤中占比极小，但对于枢椎泪滴形骨折的治疗方法存在争议，尤其是当大块撕脱骨折块有明显移位，且合并枢椎下终板严重横行损伤时。
评估前路复位、C2-3植骨融合及钢板内固定治疗合并枢椎下终板严重横行损伤的枢椎大块泪滴形骨折的临床疗效。
7例合并枢椎下终板严重横行损伤的枢椎大块泪滴形骨折患者。枢椎下终板撕脱比例为46.8±13.4%，撕脱骨折块平均旋转角度为30.4±11.7，平均移位为7.7±2.8mm。3例患者观察到枢椎体后移位。所有患者均采用颈前路咽后入路行前路复位、C2-3植骨融合及钢板内固定。随访时间为2至5年。
所有病例中，泪滴形骨折均完全复位，撕脱骨折块骨性愈合，C2-3植骨达到骨性融合。所有患者均无局部角形畸形和旋转畸形，颈椎生理前凸正常，上颈椎稳定性良好。1例美国脊髓损伤协会（ASIA）损伤分级为D级的患者术后神经功能改善为E级。6例无神经损伤的患者术后无神经症状。
前路手术是治疗合并枢椎下终板严重横行损伤的枢椎大块泪滴形骨折的有效方法。术后可实现完全复位、充分稳定及上颈椎正常生理前凸。
