阶梯式导针联合预置骨隧道置钉在Ⅱ型齿状突骨折固定中的优势

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摘要目的比较阶梯式导针法与传统经验导针法在Ⅱ型齿状突骨折手术治疗中的效果。方法回顾性分析2012年1月至2018年12月丹阳市人民医院手术治疗的17例新鲜AndersonD’Alonzo分型为Ⅱ型齿状突骨折病例资料，车祸伤11例，高处坠落伤4例，重物砸伤2例。按照术中置钉方式的不同分为A、B两组，其中A组9例采用阶梯式导针联合预置骨隧道法置钉，男6例，女3例；年龄31~62岁，平均(48.33±10.92)岁。B组8例采用传统经验法置钉，男5例，女3例；年龄32~65岁，平均(53.0±6.87)岁。比较两组手术时间、透视次数、导针置入次数、出血量、术后疼痛数字评分(numeric rating scales，NRS)、切口愈合等级、骨折愈合情况、术后颈椎残障功能指数(neck disability index，NDI)及其他并发症等。结果患者均获得随访，随访时间12~16个月，平均(13.6±3.1)个月。术前两组性别、年龄、骨折类型差异无统计学意义。两组手术时间［A组(53.33±6.87)min，B组(104.25±15.80)min］、术中透视次数［A组(5.11±0.78)次，B组(9.88±1.89)次］、导针置入次数［A组(2.33±0.50)次，B组(6.75±1.39)次］、出血量［A组(31.11±10.54)mL，B组(38.75±9.16)mL］，差异均有统计学意义(P＜0.05)。术后疼痛NRS评分A组(2.01±0.71)分，B组(2.37±1.06)分，两组比较差异无统计学意义(P＞0.05)。末次NDI评分A组(5.62±1.54)分，B组(6.11±1.72)分，两组比较差异无统计学意义(P＞0.05)。全部患者顺利完成手术，无脑脊液漏和神经血管损伤，切口除B组1例外，均Ⅰ/甲愈合。B组1例螺钉松动，颈托固定下骨折愈合。结论与传统经验导针法比较，阶梯式导针联合预置骨隧道法具有手术时间短、透视次数少、定位精准和置钉成功率高的优势，值得参考。

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	周立建
	贺双军 *
	王遥伟
	束晖
	吴树华

关键词 ：齿状突骨折, 颈前入路, 齿状突螺钉, 结果

Abstract：Objective To compare the surgical effect of stepped guide needle method and traditional guide needle method in type Ⅱ odontoid fracture fixation.Methods From January 2012 to December 2018，17 cases of fresh type ⅡAndersond ’Alonzo odontoid fracture were treated in Danyang People’s Hospital，including 11 cases of car accident injury，4 cases of high fall injury and 2 cases of heavy impact injury.According to different intraoperative screw placement methods，the patients were divided into group A and group B.In group A，9 patients (6 males and 3 females)were treated with stepped guide needle combined with preplaced bone tunnel screw placement.The age ranged from 31 to 62 years，with an average of (48.33±10.92)years.In group B，8 patients (5 males and 3 females)were treated with traditional experience screw placement.The age ranged from 32 to 65 years，with an average of (53.0±6.87)years.The operative time，number of fluoroscopy，number of guide needle insertions，amount of blood loss，numeric rating scales (NRS)of postoperative pain，incision healing grade，fracture healing，neck disability index (NDI)and other complications were compared between the two groups.Results All patients were followed up for 12~16 months，with an average follow up time of (13.6±3.1)months.There was no significant difference in gender，age and fracture type between the two groups before surgery.Operation time ［group A (53.33±6.87)min，group B (104.25±15.80)min］，intraoperative fluoroscopy times ［group A (5.11±0.78)times，group B (9.88±1.89)times］，guiding needle Adjustment times ［(2.33±0.50)times in group A，(6.75±1.39)times in group B］，bleed loss ［(31.11±10.54)mL in group A，(38.75±9.16)mL in group B］ were statistically different (P＜0.05).NRS scores of postoperative pain in group A (2.01±0.71)and group B (2.37±1.06)showed no significant difference (P＞0.05).There was no significant difference in the last NDI score between group A (5.62±1.54)and group B (6.11±1.72)(P＞0.05).All the patients completed the operation successfully without cerebrospinal fluid leakage and neurovascular injury.The incisions were healed at I/A except for 1 case in group B.The screw was loosened in 1 case in group B，and the fracture healed under cervical collar fixation.Conclusion Compared with the traditional experience of nail placement，the stepped guide wire combined with bone pre-placement tunnel method has the advantages of short operation time，less fluoroscopy，accurate positioning and high success rate of nail placement.

Key words： odontoid fracture anterior cervical approach odontoid screw outcome

通讯作者: 贺双军

作者简介: 周立建(1978－ )，男，副主任医师，丹阳市人民医院，南通大学附属丹阳医院骨科，zzlljj0828 @163.com。

引用本文:

周立建，贺双军 *，王遥伟，束晖，吴树华. 阶梯式导针联合预置骨隧道置钉在Ⅱ型齿状突骨折固定中的优势[J]. 实用骨科杂志, 2022, 28(4): 295-304.
Zhou Lijian，He Shuangjun *，Wang Yaowei，Shu Hui，Wu Shuhua. Advantages of Stepped Guide Wire Combined with Pre placed Bone Tunnel in the Fixation of Type Ⅱ Odontoid Fractures. sygkzz, 2022, 28(4): 295-304.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2022/V28/I4/295

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