Zhu Ce, Wang Lei, Liu Hao, Song Yueming, Liu Limin, Li Tao, Gong Quan
Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2017 Nov;96(44):e8521. doi: 10.1097/MD.0000000000008521.
Surgical methods for type II odontoid fracture can be classified into 2 main groups: anterior or posterior approach. A more effective way to achieve bone fusion with the lowest possible surgical risk is needed. Therefore, the aim of our study was to describe and evaluate a novel technique, cable-dragged reduction/cantilever beam internal fixation for the treatment of type II odontoid fracture.This was a retrospective study enrolled 34 patients underwent posterior cable-dragged reduction/cantilever-beam internal fixation surgery. Medical records, rates of reduction, the location of the instrumentation and fracture healing during follow-up were analyzed. Once fracture healing was obtained, instrumentation was removed. Neck pain (scored using a visual analog scale [VAS]), neck stiffness, patient satisfaction, and neck disability index (NDI) were recorded before and after removing the instrumentation during follow-up.The mean duration of follow up was 22.8 ± 5.3 months. There was no iatrogenic damage to nerves or blood vessels. Radiographic evaluation showed complete reduction in the 20 patients with fracture displacement and satisfactory fracture healing in all 34 cases. Titanium cable breakage was observed in 4 patients after fracture healing. After removal of instrumentation, significant improvements were seen in neck-pain VAS score, neck stiffness, patient satisfaction, and NDI (all P < .01).Posterior cable-dragged reduction/cantilever-beam internal fixation was an optimal salvage maneuver to conventional surgical methods such as anterior screw fixation and C1-C2 screw-rod system. The operative difficulty and incidence of nerve and vascular injury were reduced. Its major disadvantage is the exposure and screw-setting at C3, which is left intact in traditional surgery, and it is suitable only for patients with intact C1 posterior arches.
II型齿状突骨折的手术方法主要可分为两组：前路或后路。需要一种能以尽可能低的手术风险实现骨融合的更有效方法。因此，我们研究的目的是描述和评估一种新技术，即缆线牵引复位/悬臂梁内固定治疗II型齿状突骨折。
这是一项回顾性研究，纳入了34例行后路缆线牵引复位/悬臂梁内固定手术的患者。分析了病历、复位率、随访期间内固定位置及骨折愈合情况。一旦获得骨折愈合，即取出内固定。随访期间在取出内固定前后记录颈部疼痛（采用视觉模拟评分法[VAS]评分）、颈部僵硬程度、患者满意度及颈部功能障碍指数（NDI）。
平均随访时间为22.8±5.3个月。未发生医源性神经或血管损伤。影像学评估显示，20例骨折移位患者实现了完全复位，所有34例患者骨折愈合情况均令人满意。4例患者在骨折愈合后观察到钛缆断裂。取出内固定后，颈部疼痛VAS评分、颈部僵硬程度、患者满意度及NDI均有显著改善（均P<0.01）。
后路缆线牵引复位/悬臂梁内固定是一种优于前路螺钉固定和C1-C2螺钉棒系统等传统手术方法的最佳挽救性手术。手术难度以及神经和血管损伤的发生率均降低。其主要缺点是需要暴露并在C3置钉（传统手术中C3保持完整），且仅适用于C1后弓完整的患者。
