Wang Lin-Nan, Li Tao, Yang Xi, Wang Lei, Liu Li-Min, Liu Hao, Song Yue-Ming
Acta Orthop Belg. 2018 Mar;84(1):108-115.
To evaluate and compare the clinical and radiographic results between temporary C1-C2 pedicle screw fixation and cable-dragged reduction and cantilever beam internal fixation. Between 2010 and 2013, temporary C1-C2 pedicle screw fixation (Group P, 28 patients) and cable-dragged reduction following cantilever beam internal fixation (Group C, 33 patients) were performed on type II odontoid fracture cases. Implants were removed after fracture union. All of the 61 surgeries were performed successfully with no iatrogenic neurological worsen. One patient in Group P detected intra-operative vertebral artery injury. All patients gained fracture union. Among the observed indexes, only blood loss in Group P (128.9 ± 73.9ml) is statistically higher than in Group C (97.3 ± 5 4.2ml). Pedicle screw fixation carries the risk of vertebral artery injury, especially in patients with high-riding vertebral artery. Cable-dragged reduction following cantilever beam internal fixation could avoid the potential risk of vertebral injury, but it prolonged the fixed segments. We thought cable-dragged reduction following cantilever beam internal fixation could be an alternative method for treating type II odontoid fracture.
评估并比较临时C1-C2椎弓根螺钉固定与线缆牵引复位及悬臂梁内固定的临床及影像学结果。2010年至2013年期间，对II型齿状突骨折病例分别采用临时C1-C2椎弓根螺钉固定（P组，28例患者）和悬臂梁内固定后线缆牵引复位（C组，33例患者）。骨折愈合后取出植入物。61例手术均成功完成，无医源性神经功能恶化。P组有1例患者术中发现椎动脉损伤。所有患者均实现骨折愈合。在观察指标中，仅P组的失血量（128.9±73.9ml）在统计学上高于C组（97.3±54.2ml）。椎弓根螺钉固定存在椎动脉损伤风险，尤其是椎动脉高位走行的患者。悬臂梁内固定后线缆牵引复位可避免潜在的椎体损伤风险，但延长了固定节段。我们认为悬臂梁内固定后线缆牵引复位可作为治疗II型齿状突骨折的一种替代方法。
