Böhler J
J Bone Joint Surg Am. 1982 Jan;64(1):18-27.
The dens can be reached and directly stabilized from an anterior cervical approach, provided that x-ray image intensification is employed. Through this approach, twelve delayed unions and non-unions of the dens were treated with a bone graft impacted into a trough in the body of the second cervical vertebra and into a canal in the dens, together with a concomitant posterior arthrodesis. Fifteen additional fractures of the dens were stabilized with compression screws, introduced from the anteroinferior margin of the second cervical vertebra into the dens. Four of these fractures had delayed union, and an anterior onlay bone graft was added to the screw fixation. All of the delayed unions, non-unions, and acute fractures healed with bone union and without major complications. The acute fractures showed bone union in six to eight weeks after anterior fixation with compression screws alone. Delayed unions were found to need an anterior onlay bone graft in addition to the screw fixation. Established non-unions should be stabilized with a posterior arthrodesis of the first to the second cervical vertebra and inlay grafting of the non union itself to ensure both anterior and posterior healing.
只要使用X线影像增强设备，就可以通过颈椎前路到达齿突并直接进行稳定处理。通过这种方法，对12例齿突延迟愈合和不愈合患者进行了治疗，将骨块嵌入第二颈椎椎体的骨槽和齿突的管内，并同时进行后路关节融合术。另外15例齿突骨折采用加压螺钉固定，螺钉从第二颈椎椎体的前下缘插入齿突。其中4例骨折出现延迟愈合，在螺钉固定的基础上增加了前路贴敷植骨。所有延迟愈合、不愈合和急性骨折均实现骨愈合，且无严重并发症。单纯使用加压螺钉进行前路固定后，急性骨折在6至8周时实现骨愈合。发现延迟愈合除螺钉固定外还需要前路贴敷植骨。已形成的不愈合应通过第一颈椎至第二颈椎的后路关节融合术以及对不愈合部位本身进行嵌体植骨来实现稳定，以确保前后方均愈合。
