目的 探讨后路寰枢椎椎弓根螺钉内固定非融合术治疗Ⅱ型齿状突骨折的临床疗效.方法 对10例新鲜齿状突骨折采用寰枢椎椎弓根螺钉内固定,不行后路植骨融合,根据术后定期随访影像学检查确定骨折愈合后二期原路取出内固定装置,观察评价患者寰枢椎旋转功能的恢复情况.结果 10例患者均成功置入椎弓根螺钉,骨折端获解剖复位,未见脊髓、血管损伤等并发症.所有患者均获随访,随访时间12～30个月,平均18个月,末次随访时CT扫描确定骨折端达到骨性愈合,颈椎向左、右旋转30～55°,平均45°.二期钉棒内固定装置取出术后颈椎旋转功能即获部分恢复,颈椎向左、向右旋转恢复至50～70°,平均60°,随访3-6个月,颈椎左、右旋转恢复至80～90°,平均85°,基本恢复正常.结论 采用一期后路寰枢椎椎弓根螺钉非融合内固定术、二期原路取出内固定装置是治疗新鲜Ⅱ型齿状突骨折的理想手术方式,尤其适用于ⅡC型齿状突骨折,既能即刻取得解剖复位、恢复寰枢关系、达到三维固定效果,又能在内固定装置取出后极大恢复颈椎旋转功能.%Objective To evaluate the clinical effect of posterior atlantoaxial nonfasion pedicle screw fixation in the treatment of odontoid fracture.Methods 10 patients diagnosed with fresh odontoid fracture were treated with posterior aflantoaxial without bone graft fusion.According to radiological examination,the internal fixation instruments were removed through secondary operation when bony fusion of the den was observed during follow-up.Then,the rotary function of atlantoaxial joint was evaluated.Results C1/2 pedical screws were successfully inserted in 10 patients.Anatomical reduction was achieved without injuries of veterbral artery and spine cord.All patients were followed up for an average period of 18 months (ranged 12～30 months).Bony fusion was observed by radiological examination at last follow up,the cervical ROM ranged from 30°～55° (average 45°).After secondary operation,the cervical ROM ranged from 50°～70° (average 60°).In the following 3-6 months,the ROM was 80°～90° (average 85°),which was almost normal.Conclusion Posterior atlantoaxial pedicle screw fixation without fusion is safe and desired operation method in treatment of fresh edontoid fracture,especially for type Ⅱ C fracture.It can not only achieve anatomical reduction,restore aflantoaxial relation,attain stable 3D fixation effect immediately,but also can greatly preserve the C1/2 rotation function when the internal fixation is removed.
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