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寰枢椎Ⅱ型骨折经前路寰枢螺钉固定后不进行手法复位骨折线能否达到中立位?

Can The Fracture Line of Type II Odontoid Fractures Come to A Neutral Position After Anterior Odontoid Screw Fixation without a Manipulation?

机构信息

Istinye University School of Medicine, VM Medical Park Hospital Bursa, Department of Neurosurgery, Bursa, Turkey.

出版信息

Turk Neurosurg. 2022;32(5):793-801. doi: 10.5137/1019-5149.JTN.36245-21.2.

Abstract

AIM

To examine whether there was an improvement in the displaced fracture line in the follow-up, in which Anterior odontoid screw fixation (AOSF) was performed without manipulation and to determine the "displacement angle range" in which AOSF was possible.

MATERIAL AND METHODS

A total of 11 patients with the diagnosis of type II odontoid fracture who underwent AOSF without manipulation were analyzed retrospectively. A control group of 30 cases was formed and odontoid related angle measurements were performed on cervical computed tomographies (CT) of the control group and the patients who were operated.

RESULTS

In 6 of 7 cases in the posterior-displaced group along with all cases in the anterior-displaced group, it was determined that the displacement angles returned to the normal range in the 1st year follow-up. In 1 case having posterior displacement with posterior longitudinal ligament (PLL) damage, it was observed that the displacement angle improved to the normal range significantly, but the displacement continued.

CONCLUSION

AOSF is a minimally invasive, safe and effective method in patients with displaced type II odontoid fracture, which is between the median odontoidobasal angle range of 100°-134°, whose PLL is preserved, and which cannot be manipulated.

摘要

目的

探讨在不进行手法复位的情况下,经前路齿状突螺钉固定(AOSF)后,随访时齿突骨折线的移位是否得到改善,并确定 AOSF 可能的“移位角度范围”。

材料与方法

回顾性分析了 11 例未经手法复位而行 AOSF 治疗的 II 型齿突骨折患者。并设立了对照组,对对照组和手术患者的颈椎 CT 进行了齿突相关角度测量。

结果

在沿后路移位的 7 例患者中,有 6 例和所有前移位组患者在前 1 年随访时,确定其移位角度恢复到正常范围。在 1 例存在后路移位并伴有后纵韧带(PLL)损伤的患者中,观察到其移位角度显著改善至正常范围,但仍存在持续移位。

结论

对于 II 型齿突骨折,在保留 PLL 的情况下,AOSF 是一种微创、安全且有效的方法,适用于在 100°-134°的中位齿突基底线角度范围内且不能进行手法复位的患者。

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