Jenkins J D, Coric D, Branch C L
Department of Neurosurgery, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157-1029, USA.
J Neurosurg. 1998 Sep;89(3):366-70. doi: 10.3171/jns.1998.89.3.0366.
The optimal treatment of Type II odontoid fractures is controversial. Various therapies have been used, including nonrigid immobilization, halo orthosis, posterior atlantoaxial arthrodesis, and odontoid screw fixation. Of these, odontoid screw fixation is the only treatment modality that provides immediate stabilization and preserves normal motion at C1-2. It has been suggested in cadaveric biomechanical studies that there is no advantage to using more than one screw for anterior odontoid fixation. The authors compared the clinical safety and efficacy of one- and two-screw anterior odontoid fixation.
The authors retrospectively reviewed the medical records and radiographs of 42 consecutive patients who had undergone fixation for treatment of odontoid fractures at a single institution between 1989 and 1995. The group treated with a single screw consisted of 20 patients (11 males and nine females) with an average age of 54 years. The union rate in this group, as determined by postoperative dynamic radiographs, was 81%. The group treated with two screws consisted of 22 patients (13 men and nine women) with an average age of 64 years, whose union rate was 85%.
Anterior odontoid screw fixation is a safe and efficacious treatment for odontoid fractures. In the authors' experience there was no significant difference in the successful union rates achieved with either the one- or two-screw fixation techniques (81% and 85%, respectively; chi(2) = 0.09, p = 0.76).
II型齿状突骨折的最佳治疗方法存在争议。已采用多种治疗方法，包括非刚性固定、头环支具、寰枢椎后路融合术和齿状突螺钉固定。其中，齿状突螺钉固定是唯一能提供即刻稳定并保留C1-C2正常活动度的治疗方式。尸体生物力学研究表明，前路齿状突固定使用多枚螺钉并无优势。作者比较了单枚和双枚螺钉前路齿状突固定的临床安全性和疗效。
作者回顾性分析了1989年至1995年间在单一机构接受齿状突骨折固定治疗的42例连续患者的病历和X线片。单枚螺钉治疗组由20例患者（男11例，女9例）组成，平均年龄54岁。根据术后动态X线片确定，该组的愈合率为81%。双枚螺钉治疗组由22例患者（男13例，女9例）组成，平均年龄64岁，其愈合率为85%。
前路齿状突螺钉固定是治疗齿状突骨折的一种安全有效的方法。根据作者的经验，单枚或双枚螺钉固定技术的成功愈合率无显著差异（分别为81%和85%；χ² = 0.09，p = 0.76）。
