Waddell J P, Reardon G P
Can J Surg. 1983 May;26(3):255-7, 260.
The authors reviewed 132 cases of cervical spine fracture over a 10-year period and found 24 cases of fracture of the odontoid process. Using the classification of Anderson and D'Alonzo, they found 20 patients with type II fractures and 4 with type III injuries. Sixteen patients with type II fractures and 1 with type III underwent posterior atlantoaxial fusion by the Gallie method or a modification of it. Immobilization following arthrodesis was by soft cervical ruffs and a four-poster collar. Solid fusion was obtained within 3 to 6 months in 15 of the 16 type II fractures; one patient was lost to follow-up. The one patient with a type III fracture obtained a solid fusion within 3 months. One patient had the fusion revised at 1 month for progressive displacement; otherwise there were no notable complications. It is almost impossible to determine whether the fracture fragments had united but this is not important as long as there is a solid fusion. Whether treatment of acute odontoid fractures, particularly type II, should be operative or nonoperative is controversial, but from this review the authors believe that primary treatment of type II odontoid fractures by posterior atlantoaxial arthrodesis with its low morbidity and high fusion rate is superior to nonoperative treatment.
作者回顾了10年间132例颈椎骨折病例，发现其中24例为齿状突骨折。根据安德森和达隆佐的分类方法，他们发现20例为Ⅱ型骨折，4例为Ⅲ型损伤。16例Ⅱ型骨折患者和1例Ⅲ型骨折患者通过加里法或其改良方法接受了寰枢后路融合术。融合术后通过软质颈托和四柱颈托进行固定。16例Ⅱ型骨折中的15例在3至6个月内实现了牢固融合；1例患者失访。1例Ⅲ型骨折患者在3个月内实现了牢固融合。1例患者因进行性移位在1个月时进行了融合翻修；除此之外，没有明显并发症。几乎不可能确定骨折碎片是否已经愈合，但只要实现了牢固融合，这并不重要。急性齿状突骨折，尤其是Ⅱ型骨折，治疗应采用手术还是非手术方式存在争议，但通过本次回顾，作者认为寰枢后路融合术对Ⅱ型齿状突骨折进行一期治疗，具有低发病率和高融合率，优于非手术治疗。
