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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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

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	Zhou Lijian
	He Shuangjun *
	Wang Yaowei
	Shu Hui
	Wu Shuhua

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Zhou Lijian,He Shuangjun *,Wang Yaowei, et al. Advantages of Stepped Guide Wire Combined with Pre placed Bone Tunnel in the Fixation of Type Ⅱ Odontoid Fractures[J]. sygkzz, 2022, 28(4): 295-304.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2022/V28/I4/295

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