颈后路非融合寰枢椎内固定技术治疗Anderson Ⅲ型齿突骨折的临床研究

王路　程才　李书奎　李凌霞

[摘要] 目的 探讨颈后路非融合寰枢椎内固定技术对于Ⅲ型齿突骨折的治疗效果。 方法 对2006年3月～2015年3月收治的18例Ⅲ型齿状突骨折患者进行改良颈后路非融合内固定技术治疗。 结果 随访7～26（10.1±1.4）个月，18例齿突骨折均愈合，临床症状完全消失15例，明显改善3例，无脊髓神经损伤并发症，内固定物无松动断裂，术后颈椎活动度良好，颈椎JOA评分明显改善，术后效果优良率为88.9%。 结论 改良颈后路非融合内固定技术治疗Ⅲ型齿突骨折手术创伤较小，恢复快，并保留了寰枢椎的生理活动功能。

[关键词] 齿突骨折；非融合；内固定；寰枢椎；改良

[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701（2016）25-0064-03

Clinical study of non-fusion atlantoaxial internal fixation by cervical posterior approach in the treatment of anderson type Ⅲ fracture of odontoid process

WANG Lu1 CHENG Cai1 LI Shukui1 LI Lingxia2

1. Department of Orthopaedics， Cangzhou Central Hospital in Hebei Province， Cangzhou 061001， China； 2. Department of Clinical Pharmacy， Cangzhou Peoples Hospital in Hebei Province， Cangzhou 061000， China

[Abstract] Objective To investigate the efficacy of non-fusion atlantoaxial internal fixation by cervical posterior approach in treating Ⅲ type fracture of odontoid process. Methods Improved non-fusion internal fixation by cervical posterior approach was given to the 18 patients with type Ⅲ fracture of odontoid process who were admitted in our hospital from March 2006 to March 2015. Results After follow-ups for 7-26 （10.1±1.4）months， 18 cases of fracture of odontoid process were all healed. Among them， the clinical symptoms of 15 cases were completely diminished and 3 cases were obviously improved. No complications of spinal nerve injuries and no loosening or rupture of internal fixator were found. The cervical mobility after operation was good with significantly improved cervical JOA score. The good rate of postoperative efficacy was 88.9%. Conclusion Improved non-fusion internal fixation by cervical posterior approach in the treatment of type Ⅲ fracture of odontoid process is featured by minimal invasion and quick recovery， which also preserve the physiological function of atlantoaxial.

[Key words] Fracture of odontoid process； Non-fusion； Internal fixation； Atlantoaxial； Improved

随着我国交通、建筑业的快速发展，枢椎椎体骨折（齿突骨折）发生率不断升高，此类损伤是一种严重的颈椎损伤，如果骨折愈合不良不仅可以导致寰枢椎不稳定，而且可以造成高位的颈脊髓损伤，严重者可以导致生命危险，临床上一般需要手术治疗来重建寰枢关节稳定性。2006年3月～2015年3月，我科共治疗Ⅲ型齿状突骨折18例，经改良颈椎后路非融合寰枢椎内固定技术治疗，效果满意，现报道如下。

1 资料与方法

1.1一般资料

18例患者中男12例，女6例，年龄17～71岁，平均（36.9±3.4）岁，自受伤至就医时间为3 h～7 d，平均（23.5±3.7）h，临床主要表现为颈部疼痛症状和/或颈脊髓神经功能障碍症状。2例合并口腔颌面部外伤，2例合并四肢骨折。

1.2 术前准备

完善相关术前检查（血常规、凝血常规、肝肾功能、血糖、免疫、抗HIV、十二导联心电图、颈椎X线、CT及MRI，术前合并下肢功能障碍者加查双下肢血管超声），排除相关手术禁忌，术前患者枕颈部备皮并保证禁食水6 h以上。……