| 经皮前路螺钉内固定术在老年齿状突骨折中的应用 |
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Received:July 07, 2010
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| 作者 | Author | 单位 | Unit | E-Mail |
| 罗鹏 |
LUO Peng |
温州医学院附属第二医院骨科，浙江 温州 325000 |
Department of Orthopaedics,the Second Affiliated Hospital of Wenzhou Medical College,Wenzhou 325000,Zhejiang,China |
feygk@163.com |
| 窦海成 |
DOU Hai-cheng |
温州医学院附属第二医院骨科，浙江 温州 325000 |
Department of Orthopaedics,the Second Affiliated Hospital of Wenzhou Medical College,Wenzhou 325000,Zhejiang,China |
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| 倪文飞 |
NI Wen-fei |
温州医学院附属第二医院骨科，浙江 温州 325000 |
Department of Orthopaedics,the Second Affiliated Hospital of Wenzhou Medical College,Wenzhou 325000,Zhejiang,China |
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| 黄其杉 |
HUANG Qi-shan |
温州医学院附属第二医院骨科，浙江 温州 325000 |
Department of Orthopaedics,the Second Affiliated Hospital of Wenzhou Medical College,Wenzhou 325000,Zhejiang,China |
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| 王向阳 |
WANG Xiang-yang |
温州医学院附属第二医院骨科，浙江 温州 325000 |
Department of Orthopaedics,the Second Affiliated Hospital of Wenzhou Medical College,Wenzhou 325000,Zhejiang,China |
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| 徐华梓 |
XU Hua-zi |
温州医学院附属第二医院骨科，浙江 温州 325000 |
Department of Orthopaedics,the Second Affiliated Hospital of Wenzhou Medical College,Wenzhou 325000,Zhejiang,China |
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| 池永龙 |
CHI Yong-long |
温州医学院附属第二医院骨科，浙江 温州 325000 |
Department of Orthopaedics,the Second Affiliated Hospital of Wenzhou Medical College,Wenzhou 325000,Zhejiang,China |
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| 期刊信息：《中国骨伤》2011年24卷，第3期，第227-230页 |
| DOI：10.3969/j.issn.1003-0034.2011.03.015 |
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目的：探讨经皮前路螺钉内固定术治疗老年齿状突骨折的疗效。
方法：自2001年2月至2009年4月对15例老年齿状突骨折采用经皮前路螺钉内固定术，男13例，女2例；年龄60～86岁，平均69.3岁。根据Anderson分类：Ⅱ型10例，浅Ⅲ型4例，深Ⅲ型1例；10例Ⅱ型骨折按Eysel和Roosen分类，ⅡA型7例，ⅡB型3例。新鲜骨折13例，陈旧性骨折2例。所有患者有不同程度颈肩部疼痛及颈部活动受限症状，其中4例伴神经损伤症状，根据Frankel分级：D级2例，C级2例。对患者进行术后随访及影像学评估，临床检查包括术后颈部活动、神经功能及疼痛改善情况；影像学检查包括颈椎正侧位、张口位及过屈、过伸位X线片。
结果：所有患者获随访，时间6～60个月，平均31.3个月，2例随访期间死于其他疾病(分别为术后18、22个月).末次随访时内固定满意，螺钉位置良好，无偏斜，1例螺钉尾部过长，并向前方轻度压迫食管，1例纤维愈合，12例骨性愈合，2例不愈合，但无临床症状。除3例颈部旋转轻度受限外，其余患者颈部活动无明显障碍。4例伴神经损伤症状患者术后神经功能均有改善，至末次随访为止，根据Frankel分级：E级3例，D级1例。颈部疼痛较术前明显改善(P<0.001),VAS评分由术前平均(6.07±1.44)分(4～8分)降至术后的平均(1.13±0.92)分(0～3分).无严重术后并发症，无血管、神经损伤。
结论：经皮前路螺钉内固定术治疗老年齿状突骨折具有操作易、创伤小、恢复快等优点。只要全面评估患者一般情况，可达到满意的临床效果，对于齿状突粉碎性骨折、严重骨质疏松患者则不宜采用此手术。 |
| [关键词]:齿状突 骨折 骨折固定术，内 老年 |
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| Application of anterior percutaneous screw fixation in treatment of odontoid process fractures in aged people |
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Abstract:
Objective: To explore the efficacy of anterior percutaneous screw fixation in the treatment of odontoid process fractures in aged people.
Methods: From February 2001 to April 2009,15 elderly patients with odontoid fracture were treated with anterior percutaneous screw fixation,including 13 males and 2 females;the average age was 69.3 years(ranged,60 to 86 years). According to Anderson classification,there were 10 patients with typeⅡfractures(typeⅡA in 7 cases,typeⅡB in 3 cases,based on Eysel and Roosen classification),4 patients with shallow type Ⅲ fractures,1 patient with deep type Ⅲ fractures. Thirteen patients were fresh fractures,2 patients were oboslete fractures. All patients had varying degrees of neck or shoulder pain,and limit activity of neck. There were 4 patients with neural symptoms including 2 grade D and 2 grade C according to Frankel classification. All the patients were followed up and were assessed by radiology. Clinical examination included neck activity,neurological function and the degree of neck pain. Radiology examinations including anteroposterior,lateral,open mouth position and flexion-extension radiographs of cervical vertebra were performed.
Results: After surgery,all patients were followed up,and the duration ranged from 6 to 60 months(averaged 31.3 months). Two patients died of other diseases during the follow-up period(18 and 22 months after surgery respectively). All patients got satisfactory results,and all screws were in good position. As the screw was too long,esophagus was compressed by screw tail in one case. One case showed fibrous union,12 cases had achieved solid bony union,2 cases showed nonunion without clinical symptoms. The rotation of neck in 3 cases was mildly limited,the neck function of the remaining patients were normal. Four patients with symptoms nerve injuries improved after operation (Frankel E in 3 cases,Frankel D in 1 case). The symptom of neck pain had a significant improvement after surgery(P<0.001). The VAS score decreased from preoperative(6.07±1.44)(4 to 8 scores),to postoperative(1.13±0.92)(0 to 3 scores). And there were no severe postoperative complications.
Conclusion: The anterior percutaneous screw fixation is less traumatic than conventional approaches for aged people in dealing with odontoid process fractures. Most patients will achieve satisfactory clinical results,as long as the general conditions of them are comprehensively assess. However,this procedure should not be used in patients with comminuted odontoid fractures or severe osteoporosis. |
| KEYWORDS:Fascia dentata Fractures Fracture fixation,internal Aged |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 罗鹏,窦海成,倪文飞,黄其杉,王向阳,徐华梓,池永龙.经皮前路螺钉内固定术在老年齿状突骨折中的应用[J].中国骨伤,2011,24(3):227~230 |
| 英文格式: | LUO Peng,DOU Hai-cheng,NI Wen-fei,HUANG Qi-shan,WANG Xiang-yang,XU Hua-zi,CHI Yong-long.Application of anterior percutaneous screw fixation in treatment of odontoid process fractures in aged people[J].zhongguo gu shang / China J Orthop Trauma ,2011,24(3):227~230 |
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