Anterior cervical single hollow screw placement for the treatment of type Ⅱodontoid fractures

doi:10.3969/j.issn.2095-4344.2013.17.020

Abstract

Abstract:

BACKGROUND: Anterior compression screw fixation for the treatment of odontoid fractures can obtain a higher healing rate, and can retain the atlantoaxial intervertebral activities to the maximum extent.
OBJECTIVE: To analyze the effect and complications of anterior compression screw fixation for the treatment of type Ⅱ odontoid fractures.
METHODS: The odontoid fractures patients treated with anterior cervical single hollow screw fixation were selected from Department of Orthopedics, No.3 People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between August 2002 and December 2012. Forty-eight patients received the anterior compression screw fixation under the monitor of C-arm X-ray machine for the treatment of fresh type Ⅱ odontoid fractures, and then the retrospective analysis was performed. The anteroposterior and mouth-open X-ray films of upper cervical spine were taken before and after fixation and during the final follow-up period to evaluate and analyze the effect after treatment as well as the occurrence of complications.
RESULTS AND CONCLUSION: The patients were followed-up for 6-47 months, averaged 13.4 months, after treated with anterior cervical single hollow screw fixation. The results showed seven cases suffered from complications and three cases had dysphagia, and healed after 3-6 months follow-up; three cases had screw loosening, and healed after prologing the external fixation time; non-healed in one case, and then healed after posterior atlantoaxial fusion and fixation in the second stage; other cases were well-healed, and the atlantoaxial rotation function was not limited significantly after healing. Anterior cervical single hollow screw fixation for the treatment of type Ⅱ odontoid fractures has the advantages of lower incidence of complications, higher fracture healing rate and well function recovery. Strict selection of indicators and precise operation are the keys to avoid complications.

Key words: bone and joint implants, academic discussion of bone and joint implants, odontoid fractures, complication, internal fixation, screw, anterior approach, posterior fusion, fracture classification, single screw, dual screws

CLC Number:

R318

Wu Yu-jie, Zhu Tong, Shen Kang-ping, Fu Zhi-yi, Jin Wen-jie, Liu Xing-zhen. Anterior cervical single hollow screw placement for the treatment of type Ⅱodontoid fractures[J]. Chinese Journal of Tissue Engineering Research, doi: 10.3969/j.issn.2095-4344.2013.17.020.

Figures/Tables 1

3 单枚还是双枚螺钉置入内固定治疗齿状突骨折效果更好目前，前路螺钉置入内固定治疗齿状突骨折还存在一些争议，主要是在选用单枚还是双枚螺钉方面。 3.1 双枚螺钉置入内固定治疗齿状突骨折陈孝均[11]在评估实时三维图像导航下，行颈前路单枚空心螺钉内固定和双枚空心螺钉内固定治疗Anderson-DAlonzo分类Ⅱ型和Ⅲ型成人枢椎齿状突骨折的临床效果，研究共选取27例患者，男性17例，女性10例，年龄18-70岁，平均年龄37.7岁，Ⅱ型骨折19例，Ⅲ型8例。采用单螺钉内固定20例，双螺钉内固定7例。内固定后拍摄上颈椎前后位、侧位和张口位X射线片以及CT检查骨折愈合情况。应用Smiley-Webster功能结果评价量表对患者的临床结果进行分级。随访时间9-24个月，平均16个月。无论单螺钉内固定还是双螺钉内固定，所有患者骨折复位满意，骨折愈合率100%，均未出现并发症。单螺钉组Smiley-Webster分级为E级14例(70%)，G级4例(20%)，F级2例(10%)。双螺钉组Smiley-Webster分级为E级7例(100%)。研究发现，在实时三维图像导航下颈前路空心螺钉内固定是治疗成人Ⅱ型和Ⅲ型齿状突骨折的有效方法。三维导航具有操作安全、手术精度高、创伤小等优点。发现无论使用单枚螺钉还是双枚螺钉内固定均获得骨折愈合，并且功能评分没有显著性差异。 3.2 单枚螺钉置入内固定治疗齿状突骨折王晓东[12]分析颈前路单枚螺钉内固定治疗齿状突骨折的临床疗效和应用价值，对颈前路单枚螺钉内固定治疗的15例齿状突Ⅱ型骨折或Ⅲ型骨折的患者做了随访和回顾性分析，采用右侧前内侧颈横切口，切开颈阔肌并游离软组织，向外牵开颈动脉鞘，向内牵开气管食管，分离椎前筋膜，显露椎体前方，透视定位后，于C2椎体前下终板中线上旋入导针，位置满意后，在透视监视下顺导针旋入单枚相应长度的螺钉，内固定治疗后颈围制动8-12周，并随访齿状突骨折愈合情况。随访时间8-50个月，平均24个月。内固定前枕、颈后部疼痛，颈部僵硬症状，内固定后均得到了明显的改善，3例伴有神经功能障碍患者内固定后症状均有不同程度的改善。所有患者骨折复位固定满意，未发生切口感染，脊髓及神经损伤，硬脊膜破裂等并发症，所有患者在内固定后约3个月均获得骨性愈合，无不稳定或假关节形成，无螺钉松动、滑脱、断裂。对Ⅱ型或Ⅲ型齿状突骨折患者进行颈前路单枚螺钉内固定，内固定后即强度恢复成至正常的50%，颈部活动度恢复成至正常的90%，损伤较小，康复较快。减少颈部外固定时间，早期可下地活动，提高患者的生活质量，是治疗齿状突Ⅱ型或Ⅲ型骨折的一种合理有效的方法，国人适宜单枚螺钉内固定。同时，瞿东滨等[13]发现大部分国人齿状突不适合两枚3.5 mm螺钉固定。对齿状突形态进行测量，了解国人齿状突的形态特点，为齿状突螺钉设计及固定提供解剖学基础。测量60例枢椎干骨形态，30例齿状突基底部的内径及合适进钉角度。测得国人枢椎总高度为(36.8±2.4) mm，齿状突长度为(14.0±1.2) mm，基底部冠状外径为(8.9±1.0) mm，冠状内径为(6.1±0.5) mm，合适的进钉角度为(16±3)°。结果发现绝大部分国人齿状突不适合两枚3.5 mm螺钉固定，齿状突螺钉的设计应充分考虑国人齿状突的特点。绝大多数的研究结果发现，单枚螺钉置入内固定治疗齿状突骨折的效果较好，相关分析见表1。颈椎前路单枚螺钉置入内固定治疗Ⅱ型齿状突骨折不仅可以获得较好的骨折愈合率，还可以最大限度的保留寰枢椎的活动功能，相关文献分析见表2。"

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