前路经皮三钉固定治疗老年寰枢椎联合骨折

摘要

目的 探讨经皮内固定技术治疗老年(特别是合并颅脑损伤)患者急性寰枢椎联合骨折的方法及其疗效.方法 2006年3月至2011年2月,共7例老年急性寰枢椎联合骨折患者.男6例,女1例;年龄64～84岁,平均72.4岁.寰椎骨折:Jefferson骨折2例,前弓骨折2例,前后弓两处骨折2例,前后弓骨折+侧块骨折1例.枢椎齿状突骨折:AndersonⅡ型骨折6例,浅Ⅲ型骨折1例.颅脑损伤5例,均合并不同程度意识朦胧、谵妄或昏迷.对所有患者均在“C”型臂X线机监视下行经皮前路枢椎齿状突和两侧寰枢关节螺钉内固定术治疗,并分析其治疗效果.结果 手术时间36～78 min,平均56 min.同时行植骨术的患者出血20～50 ml,未行植骨术者无明显出血.7例患者均获得满意治疗效果,螺钉位置正确.无神经根、脊髓、椎动脉和食管损伤等并发症发生.全组病例平均随访10.7个月,无脱钉、弯钉及断钉发生,枢椎齿状突骨折均骨性愈合,无寰枢关节不稳.结论 对于老年特别是合并颅脑损伤患者的急性寰枢椎联合骨折,经皮前路三钉固定技术是一种简单、安全和有效的方法,有利于对患者临床护理和早期功能训练,减少并发症的发生.%Objective To evaluate the clinical effect of the percutaneous fixation for atlas-axis combined fractures in the elderly patients,especially with brain injury.Methods From March 2006 to February 2011,a total of 7 cases with C1,2 combined fractures entered the study,including 5 males and 1 female with an average age of 72.4 years (range,64-84 years).Fracture combinations included two Jefferson/type Ⅱ odontoid,two anterior ring/type Ⅱ odontoid,two anterior and posterior ring/type Ⅱ odontoid,and one anterior and posterior ring+lateral mass/type Ⅲ odontoid.There were 5 patients with head injuries in varying degrees of coma.All patients underwent percutaneous placement of odontoid screw and anterior C1,2 transarticular screws (triple anterior screw fixation),and were immobilized in a hard collar for 3 months postoperatively.Results The average duration of the operation was 56 min (range,36-78 min).Satisfactory results were achieved in all patients,and all screws were in good position.There were no intraoperative surgery-related complications.The mean follow-up period was 10.7 months.During the follow-up,no pullout,loosening,distortion,or breakage of internal screws was observed.Radiographic union occurred in all odontoid fractures and C1,2 stable was found in all case.Conclusion For elderly patients especially those with brain injury,the triple anterior screw fixation is reliable and effective in dealing with combined atlas-axis fractures.This percutaneous surgery has the advantages of less invasive,less blood loss,less pain and early recovery.