Yang Qi-Yua, Feng Jing, Luo Xiao-Li, Yang Wen-Dong, Li Ying-Bo, Fan Bin, Feng Zhi, Lai Xian-Jin
Department of Spinal Surgery, the Third People's Hospital of Mianyang City, Mianyang 621000, Sichuan, China;
Department of Spinal Surgery, the Third People's Hospital of Mianyang City, Mianyang 621000, Sichuan, China.
Zhongguo Gu Shang. 2016 Oct 25;29(10):892-897. doi: 10.3969/j.issn.1003-0034.2016.10.005.
To explore the clinical effects of surgical treatment with cable dragged reduction and cantilever beam internal fixation by posterior approach for odontoid fracture associated with atlantoaxial dislocation.
The clinical data of 12 patients with odontoid fracture associated with atlantoaxial dislocation from January 2008 to December 2013 were retrospectively analyzed. There were 8 males and 4 females, ranging in age from 21 to 53 years with an average of 37.2 years. Eleven cases were fresh fracture and 1 case was old fracture, all patients complicated with atlantoaxial anterior dislocation. According to Anderson-D' Alonzo typing method modified by Grauer, 3 cases were type IIA, 5 cases were type IIB, 3 cases were type IIC, and 1 case was type IIIA. All patients underwent surgical treatment with cable dragged reduction and cantilever beam internal fixation by posterior approach. JOA score and ADI method were respectively used to evaluate the nerve function and reductive condition of atlantoaxial dislocation.
All patients were followed up from 6 months to 2 years with an average of 1 year and 3 months. At 1 week, 6 months after operation, and final follow up, JOA scores were 13.2±1.3, 13.5±1.4, 14.3±1.5, respectively, and these data were obviously better than that of preoperative 8.3±1.4(<0.05). Postoperative X rays and CT showed satisfactory reduction of atlantoaxial dislocation. At 1 week, 6 months after operation, and final follow up, ADI were (2.2±0.4), (2.4±0.6), (2.3±0.5) mm, respectively, and these data were obviously better than that of preoperative.(5.8±1.2) mm(<0.05). All screws and cables had good location without looseness and breakage, and bone graft got fusion.
Surgical treatment with cable dragged reduction and cantilever beam internal fixation by posterior approach for odontoid fracture associated with atlantoaxial dislocation is a good method, with advantage of firm fixation and high safety. It could obtain good clinical effects.
探讨后路缆线牵引复位及悬臂梁内固定手术治疗齿状突骨折合并寰枢椎脱位的临床效果。
回顾性分析2008年1月至2013年12月收治的12例齿状突骨折合并寰枢椎脱位患者的临床资料。男8例，女4例；年龄21～53岁，平均37.2岁。新鲜骨折11例，陈旧骨折1例，均合并寰枢椎前脱位。按Grauer改良的Anderson-D’Alonzo分型方法，ⅡA型3例，ⅡB型5例，ⅡC型3例，ⅢA型1例。所有患者均采用后路缆线牵引复位及悬臂梁内固定手术治疗。分别采用JOA评分法和ADI法评估神经功能及寰枢椎脱位复位情况。
所有患者随访6个月至2年，平均1年3个月。术后1周、6个月及末次随访时，JOA评分分别为13.2±1.3、13.5±1.4、14.3±1.5，均明显优于术前的8.3±1.4（<0.05）。术后X线及CT显示寰枢椎脱位复位满意。术后1周、6个月及末次随访时，ADI分别为（2.2±0.4）、（2.4±0.6）、（2.3±0.5）mm，均明显优于术前的（5.8±1.2）mm（<0.05）。所有螺钉及缆线位置良好，无松动及断裂，植骨融合。
后路缆线牵引复位及悬臂梁内固定手术治疗齿状突骨折合并寰枢椎脱位是一种较好的方法，固定牢固，安全性高，可获得良好的临床效果。
