Yuan Suomao, Wei Bin, Tian Yonghao, Yan Jun, Xu Wanlong, Wang Lianlei, Liu Xinyu
Spine Center, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, People's Republic of China.
Reproductive Medicine Centre, Maternal and Child Health Care Hospital of Shandong Province, Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China, Jinan, 250014, People's Republic of China.
J Orthop Surg Res. 2018 Jan 8;13(1):3. doi: 10.1186/s13018-017-0702-0.
Recently, the excellent outcomes of temporary fixation of C1-2 without fusion in the treatment of odontoid fracture had been reported. It is still unclear if this technique could achieve the equivalent outcomes as the golden standard technique of anterior screw fixation. The objective of this study is to compare the clinical outcome of two treatments of fresh type II odontoid fracture: anterior cannulated screws fixation (ACSF) versus posterior instrumentation of C1-2 without fusion (PIWF).
This is a retrospective study. This series included 28 males and 8 females, and the mean age was 41.5 years (range, 22 to 70 years). Eleven patients were treated with ACSF, and 25 patients with PIWF. For PIWF, the implants were removed after fracture union was confirmed at 0.75~1.5 years later. All patients underwent preoperative and serial postoperative clinical examinations at approximately 3 months, 6 months, and annually thereafter. The neck disability index (NDI) was used to assess the neck discomfort caused by the operation. The range of rotary motion was evaluated at each visit. All fractures were reassessed postoperatively with serial X-films and CT scans of the cervical spine at each follow-up visit, to evaluate screw position, fracture alignment, and fusion status.
All patients achieved immediate spinal stabilization after surgery, and none experienced neurologic deterioration. The follow-up periods ranged from 24 to 60 months. The average range of neck rotation was dramatically lost in PIWF after fixation (46° and 89° respectively in ACSF and PIWF), and recovered to 83° after the implant was removed. The NDI in PIWF was statistically higher than that in ACSF (5 and 13% respectively in ACSF and PIWF) after the first operation and decreased to 8% 1 year after the secondary operation. The fusion rates were 90.9 and 96% respectively in ACSF and PIWF. Both groups had a case of fracture non-union.
For fresh type II odontoid fractures, high rate of fracture union can be achieved by both ACSF and PIWF. For most fresh type II odontoid fractures, anterior screw fixation was the best option for its simplicity and preservation of normal atlanto-axial rotary function. Posterior instrumentation without fusion could preserve most of the atlanto-axial rotary function and lead to moderate neck discomfort and is also a good alternative if anterior screw fixation is contraindicated.
最近，有报道称C1-2临时固定而非融合治疗齿状突骨折取得了良好效果。该技术是否能达到前路螺钉固定这一金标准技术的等效效果仍不清楚。本研究的目的是比较新鲜II型齿状突骨折两种治疗方法的临床疗效：前路空心螺钉固定（ACSF）与C1-2后路非融合内固定（PIWF）。
这是一项回顾性研究。该系列包括28例男性和8例女性，平均年龄41.5岁（范围22至70岁）。11例患者接受ACSF治疗，25例患者接受PIWF治疗。对于PIWF，在0.75至1.5年后确认骨折愈合后取出植入物。所有患者在术前及术后约3个月、6个月及此后每年进行系列临床检查。采用颈部功能障碍指数（NDI）评估手术引起的颈部不适。每次随访时评估旋转运动范围。每次随访时通过颈椎系列X线片和CT扫描对所有骨折进行术后重新评估，以评估螺钉位置、骨折对线和融合情况。
所有患者术后均立即实现脊柱稳定，无一例出现神经功能恶化。随访期为24至60个月。PIWF固定后颈部平均旋转范围显著减小（ACSF和PIWF分别为46°和89°），植入物取出后恢复至83°。首次手术后PIWF的NDI在统计学上高于ACSF（ACSF和PIWF分别为5%和13%），二次手术后1年降至8%。ACSF和PIWF的融合率分别为90.9%和96%。两组均有1例骨折不愈合病例。
对于新鲜II型齿状突骨折，ACSF和PIWF均可实现较高的骨折愈合率。对于大多数新鲜II型齿状突骨折，前路螺钉固定因其操作简单且能保留正常寰枢椎旋转功能，是最佳选择。后路非融合内固定可保留大部分寰枢椎旋转功能，但会导致中度颈部不适，在前路螺钉固定禁忌时也是一个不错的选择。
