Zhao Zhong-Sheng, Wu Guang-Wen, Lin Jie, Zhang Ying-Sheng, Huang Yan-Feng, Chen Zhi-Da, Lin Bin, Zheng Chun-Song
Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
Department of Orthopedics, The 175th Hospital of PLA, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, Fujian, China.
Indian J Orthop. 2019 Jul-Aug;53(4):518-524. doi: 10.4103/ortho.IJOrtho_249_18.
To evaluate the therapeutic effects of combined atlas fracture with type II (C-type II) odontoid fractures and to outline a management strategy for it.
Twenty three patients with C-type II odontoid fractures were treated according to our management strategy. Nonoperative external immobilization in the form of cervical collar and halo vest was used in 13 patients with stable atlantoaxial joint. Surgical treatment was early performed in 10 patients whose fractures with traumatic transverse atlantal ligament disruption or atlantoaxial instability. The visual analog scale (VAS), neck disability index (NDI) scale, and American Spinal Injury Association (ASIA) scale at each stage of followup were then collected and compared.
Compared to pretreatment, the VAS score, NDI score, and ASIA scale were improved among both groups at followup evaluation after treatment. However, in the nonsurgical group, one patient (1/11) developed nonunion which required surgical treatment in later stage and one patient (1/13) with halo vest immobilization had happened pin site infection. Two patients of the surgical group (2/11) had appeared minor complications: occipital cervical pain in one case and cerebrospinal fluid leakage in one case. Two patients (2/23) were excluded from nonsurgical treatment group because their followup period was less than 12 months. Twenty one patients were followed up regularly with an average of 23.9 months (range 15-45 months).
We outlined our concluding management principle for the treatment of C-type II odontoid fractures based on the nature of C fracture and atlantoaxial stability. The treatment principle can obtain satisfactory results for the management of C-type II odontoid fractures.
评估合并寰椎骨折的II型（C型II）齿状突骨折的治疗效果，并概述其治疗策略。
23例C型II齿状突骨折患者按照我们的治疗策略进行治疗。13例寰枢关节稳定的患者采用颈托和头环背心形式的非手术外固定。10例伴有创伤性寰椎横韧带断裂或寰枢椎不稳定骨折的患者早期接受手术治疗。然后收集并比较随访各阶段的视觉模拟量表（VAS）、颈部功能障碍指数（NDI）量表和美国脊髓损伤协会（ASIA）量表。
与治疗前相比，两组患者治疗后随访评估时的VAS评分、NDI评分和ASIA量表均有所改善。然而，非手术组有1例患者（1/11）发生骨不连，后期需要手术治疗，1例采用头环背心固定的患者（1/13）发生针道感染。手术组有2例患者（2/11）出现轻微并发症：1例枕颈部疼痛，1例脑脊液漏。2例患者（2/23）因随访时间不足12个月被排除在非手术治疗组之外。21例患者接受定期随访，平均随访时间为23.9个月（范围15 - 45个月）。
我们根据C型骨折的性质和寰枢椎稳定性概述了C型II齿状突骨折的最终治疗原则。该治疗原则可在C型II齿状突骨折的治疗中取得满意效果。
