颈前路单枚空心螺钉治疗齿状突Ⅱ型骨折疗效分析
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摘要
目的
探讨颈前路单枚齿状突空心螺钉治疗Ⅱ型齿状突骨折的疗效。
方法
2005年8月至2010年7月,我科收治35例Ⅱ型齿状突骨折(屈曲型25例,伸展型10例),男23例,女12例;年龄15-71岁,平均34岁。患者均未见明显神经压迫症状,术前均行颅骨牵引,完全复位30例,未完全复位5例。为防止术后骨不连,所有患者行颈前路电视下闭合复位单枚空心螺钉内固定术。
结果
所有患者均获得随访,随访时间6~60个月,平均36个月,平均手术时间105 min,颈部疼痛症状完全缓解,颈椎生理曲度保持良好,骨折愈合率100%,无内固定松动、断钉等并发症。
结论
应用颈前路单枚齿状突空心螺钉治疗Ⅱ型齿状突骨折,是一种安全、有效的治疗方法。
Objective:
To observe the clinical effect of anterior single-screw fixation for typeⅡodontoid fracture.
Methods:
From August 2005 to July 2010, 35 patients (average 34 years, range:15-71years, 23 males and 12 females) with typeⅡodontoid fracture underwent anterior single-screw fixation. Spinal cord compression was not found in any patient. The diagnostic categories included 25 flexion fractures and 10 extension fractures. In all the cases, traction was adopted before operation. Complete reduction was obtained in 30 cases. In order to prevent the nonunion of the fractures, anterior single-screw fixations were adopted for all patients.
Results:
The follow-up periods for all the 35 patients ranged from 6 to 60 months with an average of 36 months. The average operating time was 105 minutes. No patients experienced worsening neurological postoperatively. No other intra- or post-operative complication was observed. All patients axial pain was relieved after surgery. Each patient can maintain good cervical physiological curvature. Each patient obtained bone healing within 10 months (average 5 months). No screws complication was observed in any of the follow-up period.
Conclusion:
Anterior single-screw fixation may be a feasible and safe way to treat typeⅡodontoid fracture.
探讨颈前路单枚齿状突空心螺钉治疗Ⅱ型齿状突骨折的疗效。
方法
2005年8月至2010年7月,我科收治35例Ⅱ型齿状突骨折(屈曲型25例,伸展型10例),男23例,女12例;年龄15-71岁,平均34岁。患者均未见明显神经压迫症状,术前均行颅骨牵引,完全复位30例,未完全复位5例。为防止术后骨不连,所有患者行颈前路电视下闭合复位单枚空心螺钉内固定术。
结果
所有患者均获得随访,随访时间6~60个月,平均36个月,平均手术时间105 min,颈部疼痛症状完全缓解,颈椎生理曲度保持良好,骨折愈合率100%,无内固定松动、断钉等并发症。
结论
应用颈前路单枚齿状突空心螺钉治疗Ⅱ型齿状突骨折,是一种安全、有效的治疗方法。
Objective:
To observe the clinical effect of anterior single-screw fixation for typeⅡodontoid fracture.
Methods:
From August 2005 to July 2010, 35 patients (average 34 years, range:15-71years, 23 males and 12 females) with typeⅡodontoid fracture underwent anterior single-screw fixation. Spinal cord compression was not found in any patient. The diagnostic categories included 25 flexion fractures and 10 extension fractures. In all the cases, traction was adopted before operation. Complete reduction was obtained in 30 cases. In order to prevent the nonunion of the fractures, anterior single-screw fixations were adopted for all patients.
Results:
The follow-up periods for all the 35 patients ranged from 6 to 60 months with an average of 36 months. The average operating time was 105 minutes. No patients experienced worsening neurological postoperatively. No other intra- or post-operative complication was observed. All patients axial pain was relieved after surgery. Each patient can maintain good cervical physiological curvature. Each patient obtained bone healing within 10 months (average 5 months). No screws complication was observed in any of the follow-up period.
Conclusion:
Anterior single-screw fixation may be a feasible and safe way to treat typeⅡodontoid fracture.
引文
[1] Christenson PC: The radiologyic study of the spine. Radiol Clin N Amer 15:133,1977.
[2] Dolan KD: Cervical basilar relationship Radiol Clin N Amer 15:155,1977.
[3] Moore K L. The Developing Human.8th edition. Saunders,2008.
[4] Sadler T W. Longman’s Medical Embryology. 9th edition. Lippincott Wilkins,2004.
[5]朱海波.枢椎解剖学测量及临床意义,解剖学杂志,1997,20(4):305-309.
[6]侯黎升.枢椎各结构的解剖学部位研究,中国临床解剖学杂志,2002,20(3):172-175.
[7] Alfieri A(2001) Single-screw fixation for acute typeⅡodontoid fracture.J Neurosurg Sci 45:15-18.
[8] Anderson LD,D’Alonzo (1974) Fractures of the odontoid process of the axis.J Bone Joint Surg Am 56:1663-1674.
[9] Hanssen AD, Cabanela ME (1987) Fractures of the dens in adult patients.J Trauma 27:928.
[10] Fountas KN,Machinis TG(2005) Surgical treatment of acute typeⅡand rostral typeⅢodontoid fractures managed by anterior screw fixation.South Med J 98:896-901.
[11] Carlson GD, Heller JG(1998) Odontoid fractures. In:Levine AM (ed) Spine trauma:227-248.
[12] Fountas KN, Kapsalaki EZ(2005) Results of long-term follow-up in patients undergoing anterior screw fixation for typeⅡand rostral typeⅢodontoid fractures. Spine 30:661-669.
[13] Schatzker J, Rorabeck C H, Fractures of the odontoid process of the axis: an analysis of 37 cases. J Bone Joint Surg(1971):392-405.
[14] Schiff D M, Parke W W. The anterial supply of the odontoid process. J Bone Joint Surg(1973):1450-1456.
[15] Fischer L P, Carrett G P. La vascularisation arterielle of the axis. Bull Assoc Anat(1976),60(169):335-346.
[16] Moradian W A, Fietti V G, Fractures of the odontoid. A laboratory and clinical study of mechanism. Orthop Clin North Am(1978):985-1001.
[17] Althoff B. Fracture of the odontoid process: an experimental and clinical study. Acta Orthop Scand Suppl(1979):10-95.
[18] Lind B,Sihlbom H, Halo-vest treatment of unstable traumatic cervical spine injuries. Spine(1988)13:425-432.
[19] Ryan MD, Taylor TK, Odontoid fractures. A rational approach to treatment. J Bone Joint Surg Br(1982)64:416-421.
[20] Schweigel JF, Management of the fractured odontoid with halo-thoracic bracing. Spine(1987)12:838-839.
[21] Wang GJ,Mabie KN, The nonsurgical management of odontoid fractures in adults. Spine(1984)9:229-230.
[22] Montesano PX, Anderson PA, Odontoid fractures treated by anterior odontoid screw fixation. Spine(1991)16:S33-S37.
[23] Pepin JW, Bourne RB, Odontoid fractures, with special reference to the elderly patient. Clin Orthop(1985)193:178-183.
[24] Clark CR, White AA, Fractures of the dens. A multicenter study. J Bone Joint Surg Am(1985)67:1340-1348.
[25] Coyne TJ, Fehlings MG,C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery(1995)37:688-692.
[26] Fujii E, Kobayashi K, Treatment in fractures of the odontoid process. Spine(1988)13:604-609.
[27] Hohl M,Normal motions in the upper portion of the cervical spine. J Bone Joint Surg Am(1964)46:1777-1779.
[28] Nakanishi T, Sasaki T, Internal fixation for the odontoid fracture. Orthop Trans(1982)6:176.
[29] Bohler J, Anterior stabilization for acute fractures and non-unions of the dens. J Bone Joint Surg Am(1982)64:18-27.
[30] Aebi M, Etter C, Fractures of the odontoid process. Treatment with anterior screw fixation. Spine(1989)14:1065-1070.
[31] Apfelbaum RI, Lonser RR, Direct anterior screw fixation for recent and remote odontoid fractures. J Neurosurg(2000)93:S227-S236.
[32] Elsaghir H, Bohm H, Anderson typeⅡfracture of the odontoid process: results of anterior screw fixation. J Spinal Disord(2000)13:527-530.
[33] Henry AD, Bohly J, Fixation of odontoid fractures by an anterior screw. J Bone Joint Surg Br(1999)81:472-477.
[34] Jenkins JD, Coric D, A clinical comparison of one-and two-screw odontoid fixation. J Neurosurg(1998)89:366-370.
[35] Subach BR, Morone MA, Management of acute odontoid fractures with single-screw anterior fixation. Neurosurgery(1999)45:812-819.
[36] Chang KW, Liu YW, One Herbert double-threaded compression screw fixation of displaced typeⅡodontoid fractures.J Spinal Disord(1994):62-69.
[37] Mc Cullen GM, Cervical spine internal fixation using screw and screw-plate constructs.Spine(2000)25:643-652.
[38] Graziano G, Jaggers C, A comparative study of fixation techniques for typeⅡfractures of the odontoid process. Spine(1993)18:2383-2387.
[39] Sasso R, Doherty BJ, Biomechanics of odontoid fracture fixation. Comparison of the one- and two-screw technique. Spine(1993)18:1950- 1953.
[40] Jenkins JD, Coric D, A clinical comparison of one- and two-screw odontoid fixation. J Neurosurg(1998)89:366-370.
[41] Doherty BJ, Heggeness MH, Quantitative anatomy of the second cervical vertebra. Spine(1995)20:513-517.
[42] Heller JG, Alson MD, Quantitative internal dens morphology. Spine(1992)17:861-866.
[43] Graham JJ, Compllications of cervical spine surgery. A five-year report on asurvey of the membership of the Cervical Spine Research Society by the Morbidity and Mortality Committee. Spine(1989)14:1046-1050.
[44] Sugar O, Spinal cord malfunction after anterior cervical discectomy. Surg Neurol(1981)15:4-8.
[45] Zeidman S, Ducker T, Trends and complications in cervical spine suugery. J Spinal Disord(1997)10:523-526.
[46] Gallie W E. Fracture and dislocations of the cervical spine. American Journal of Surgery(1939)46:496-499.
[47] Brooks A L, Jenkins E B, Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg(1978)60:279-284.
[48] Tucker H H, Technical report: Method of fixation of subluxed or dislocated cervical spine below C1-C2. Can J Neurol Sci(1975)2:381-382.
[49] Huang CI, Chen IH, Atlantoaxial arthrodesis using Halifax interlaminar clamps reinforced by halo vest immobilisation:a long-term follow-up experience. Neurosurgery(1996)38:1153–1156.
[50] Statham P, O’Sullivan M, The Halifax Interlaminar clampfor posterior cervical fusion: initial experiencein the United Kingdom. Neurosurgery(1993)32:396–398.
[51] Magerl F, Seemann P S, Stable posterior fusion of the atlas and axis by transarticular screw fixation. The Cervical Spine Springer, New York Vienna(1987):322-327.
[52] Harms J,Melcher RP, Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (2001)26:2467–2471.
[53] Kim DH, Vaccaro AR, Early predictive value of supine and upright X-ray films of odontoid fractures treated with halo-vest immobilization. Spine J(2008)8: 612-618.
[54] Chibbaro S, Benvenuti L, The use of virtual fluoroscopy in managing acute typeⅡo dontoid fracture with anterior single-screw fixation. A safe, effective,elegant and fast form of treatment. Acta Neurochir(2005)147:735-739.
[55] Ben-Galim P, Reitman CA,Direct transoral manipulation to reduce a displaced odontoid fracture: a technical note. Spine J(2008)8: 818-820.
[56] Rauasekaran S,Odontoid anterior screw fixation. Eur Spine J( 2010)19: 339-340.
[57] Grauer JN, Shafi B, Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J(2005)5: 123-129.
[58] Coyne TJ, Fehlings MG, C1-C2 posterior cervical fusion:long-term evaluation of results and efficacy. Neurosurgery(1995)37: 688-693.
[2] Dolan KD: Cervical basilar relationship Radiol Clin N Amer 15:155,1977.
[3] Moore K L. The Developing Human.8th edition. Saunders,2008.
[4] Sadler T W. Longman’s Medical Embryology. 9th edition. Lippincott Wilkins,2004.
[5]朱海波.枢椎解剖学测量及临床意义,解剖学杂志,1997,20(4):305-309.
[6]侯黎升.枢椎各结构的解剖学部位研究,中国临床解剖学杂志,2002,20(3):172-175.
[7] Alfieri A(2001) Single-screw fixation for acute typeⅡodontoid fracture.J Neurosurg Sci 45:15-18.
[8] Anderson LD,D’Alonzo (1974) Fractures of the odontoid process of the axis.J Bone Joint Surg Am 56:1663-1674.
[9] Hanssen AD, Cabanela ME (1987) Fractures of the dens in adult patients.J Trauma 27:928.
[10] Fountas KN,Machinis TG(2005) Surgical treatment of acute typeⅡand rostral typeⅢodontoid fractures managed by anterior screw fixation.South Med J 98:896-901.
[11] Carlson GD, Heller JG(1998) Odontoid fractures. In:Levine AM (ed) Spine trauma:227-248.
[12] Fountas KN, Kapsalaki EZ(2005) Results of long-term follow-up in patients undergoing anterior screw fixation for typeⅡand rostral typeⅢodontoid fractures. Spine 30:661-669.
[13] Schatzker J, Rorabeck C H, Fractures of the odontoid process of the axis: an analysis of 37 cases. J Bone Joint Surg(1971):392-405.
[14] Schiff D M, Parke W W. The anterial supply of the odontoid process. J Bone Joint Surg(1973):1450-1456.
[15] Fischer L P, Carrett G P. La vascularisation arterielle of the axis. Bull Assoc Anat(1976),60(169):335-346.
[16] Moradian W A, Fietti V G, Fractures of the odontoid. A laboratory and clinical study of mechanism. Orthop Clin North Am(1978):985-1001.
[17] Althoff B. Fracture of the odontoid process: an experimental and clinical study. Acta Orthop Scand Suppl(1979):10-95.
[18] Lind B,Sihlbom H, Halo-vest treatment of unstable traumatic cervical spine injuries. Spine(1988)13:425-432.
[19] Ryan MD, Taylor TK, Odontoid fractures. A rational approach to treatment. J Bone Joint Surg Br(1982)64:416-421.
[20] Schweigel JF, Management of the fractured odontoid with halo-thoracic bracing. Spine(1987)12:838-839.
[21] Wang GJ,Mabie KN, The nonsurgical management of odontoid fractures in adults. Spine(1984)9:229-230.
[22] Montesano PX, Anderson PA, Odontoid fractures treated by anterior odontoid screw fixation. Spine(1991)16:S33-S37.
[23] Pepin JW, Bourne RB, Odontoid fractures, with special reference to the elderly patient. Clin Orthop(1985)193:178-183.
[24] Clark CR, White AA, Fractures of the dens. A multicenter study. J Bone Joint Surg Am(1985)67:1340-1348.
[25] Coyne TJ, Fehlings MG,C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery(1995)37:688-692.
[26] Fujii E, Kobayashi K, Treatment in fractures of the odontoid process. Spine(1988)13:604-609.
[27] Hohl M,Normal motions in the upper portion of the cervical spine. J Bone Joint Surg Am(1964)46:1777-1779.
[28] Nakanishi T, Sasaki T, Internal fixation for the odontoid fracture. Orthop Trans(1982)6:176.
[29] Bohler J, Anterior stabilization for acute fractures and non-unions of the dens. J Bone Joint Surg Am(1982)64:18-27.
[30] Aebi M, Etter C, Fractures of the odontoid process. Treatment with anterior screw fixation. Spine(1989)14:1065-1070.
[31] Apfelbaum RI, Lonser RR, Direct anterior screw fixation for recent and remote odontoid fractures. J Neurosurg(2000)93:S227-S236.
[32] Elsaghir H, Bohm H, Anderson typeⅡfracture of the odontoid process: results of anterior screw fixation. J Spinal Disord(2000)13:527-530.
[33] Henry AD, Bohly J, Fixation of odontoid fractures by an anterior screw. J Bone Joint Surg Br(1999)81:472-477.
[34] Jenkins JD, Coric D, A clinical comparison of one-and two-screw odontoid fixation. J Neurosurg(1998)89:366-370.
[35] Subach BR, Morone MA, Management of acute odontoid fractures with single-screw anterior fixation. Neurosurgery(1999)45:812-819.
[36] Chang KW, Liu YW, One Herbert double-threaded compression screw fixation of displaced typeⅡodontoid fractures.J Spinal Disord(1994):62-69.
[37] Mc Cullen GM, Cervical spine internal fixation using screw and screw-plate constructs.Spine(2000)25:643-652.
[38] Graziano G, Jaggers C, A comparative study of fixation techniques for typeⅡfractures of the odontoid process. Spine(1993)18:2383-2387.
[39] Sasso R, Doherty BJ, Biomechanics of odontoid fracture fixation. Comparison of the one- and two-screw technique. Spine(1993)18:1950- 1953.
[40] Jenkins JD, Coric D, A clinical comparison of one- and two-screw odontoid fixation. J Neurosurg(1998)89:366-370.
[41] Doherty BJ, Heggeness MH, Quantitative anatomy of the second cervical vertebra. Spine(1995)20:513-517.
[42] Heller JG, Alson MD, Quantitative internal dens morphology. Spine(1992)17:861-866.
[43] Graham JJ, Compllications of cervical spine surgery. A five-year report on asurvey of the membership of the Cervical Spine Research Society by the Morbidity and Mortality Committee. Spine(1989)14:1046-1050.
[44] Sugar O, Spinal cord malfunction after anterior cervical discectomy. Surg Neurol(1981)15:4-8.
[45] Zeidman S, Ducker T, Trends and complications in cervical spine suugery. J Spinal Disord(1997)10:523-526.
[46] Gallie W E. Fracture and dislocations of the cervical spine. American Journal of Surgery(1939)46:496-499.
[47] Brooks A L, Jenkins E B, Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg(1978)60:279-284.
[48] Tucker H H, Technical report: Method of fixation of subluxed or dislocated cervical spine below C1-C2. Can J Neurol Sci(1975)2:381-382.
[49] Huang CI, Chen IH, Atlantoaxial arthrodesis using Halifax interlaminar clamps reinforced by halo vest immobilisation:a long-term follow-up experience. Neurosurgery(1996)38:1153–1156.
[50] Statham P, O’Sullivan M, The Halifax Interlaminar clampfor posterior cervical fusion: initial experiencein the United Kingdom. Neurosurgery(1993)32:396–398.
[51] Magerl F, Seemann P S, Stable posterior fusion of the atlas and axis by transarticular screw fixation. The Cervical Spine Springer, New York Vienna(1987):322-327.
[52] Harms J,Melcher RP, Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (2001)26:2467–2471.
[53] Kim DH, Vaccaro AR, Early predictive value of supine and upright X-ray films of odontoid fractures treated with halo-vest immobilization. Spine J(2008)8: 612-618.
[54] Chibbaro S, Benvenuti L, The use of virtual fluoroscopy in managing acute typeⅡo dontoid fracture with anterior single-screw fixation. A safe, effective,elegant and fast form of treatment. Acta Neurochir(2005)147:735-739.
[55] Ben-Galim P, Reitman CA,Direct transoral manipulation to reduce a displaced odontoid fracture: a technical note. Spine J(2008)8: 818-820.
[56] Rauasekaran S,Odontoid anterior screw fixation. Eur Spine J( 2010)19: 339-340.
[57] Grauer JN, Shafi B, Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J(2005)5: 123-129.
[58] Coyne TJ, Fehlings MG, C1-C2 posterior cervical fusion:long-term evaluation of results and efficacy. Neurosurgery(1995)37: 688-693.