经后路侧块螺钉悬臂梁技术治疗齿状突II型骨折临床效果分析

Clinical Efficacy Analysis of Posterior Lateral Mass Screw Cantilever Technique in the Treatment of Type II Odontoid Fractures

摘要: 目的：回顾分析经后路侧块螺钉结合悬臂梁技术提拉复位固定治疗II齿状突骨折患者的临床效果。方法：分析我院自2015年11月至2022年11月经颈后路侧块螺钉结合悬臂梁技术提拉复位固定治疗II型齿状突骨折32例患者临床资料。其中男23例，女9例；年龄24~65，平均43.6 ± 13.1岁。车祸伤26例，高坠伤6例。IIa型16例，IIb型9例，IIc型7例。所有病例均有不同程度的枕颈部疼痛及活动受限，VAS评分5~10分，平均7.5 ± 1.3分。其中11例患者有不同程度脊髓神经损伤表现，其中ASIA分级D级7例，C级4例；JOA评分9~13分，平均11.4 ± 1.2分。所有患者均行经后路侧块螺钉结合钛缆悬梁支撑提拉复位固定并椎板间植骨术。结果：所有患者均顺利完成手术，术中均未发生血管、脊髓、神经损伤。所有病例均获得随访，随访时间1~3年，随访期间未发生内固定位置松动及寰椎后弓切割骨折。手术后一周、6个月及末次随访的VAS评分分别为3.9 ± 1.0、1.3 ± 0.9、0.8 ± 0.7分，均较术前7.5 ± 1.3分明显改善(P < 0.001)。11例合并脊髓损伤患者末次随访时均有所改善，9例(82%)神经功能提升1级，2例(18%)神经功能提升2级；术后一周、6个月及末次随访的JOA评分分别为13.7 ± 1.3、15.6 ± 1.1、16.2 ± 0.6分，均较术前明显改善(P < 0.001)。末次随访寰枢椎复位位置良好，螺钉、U形棒、钛缆无松动、断裂。术后6月齿状突骨折愈合17例，骨折愈合率53.13%，术后12月骨折愈合25例，愈合率78.13%，术后18月骨折愈合29例，愈合率90.62%，术后36月3例骨折未愈合，未愈合率9.38%，但所有患者后路植骨均获得良好融合。结论：经后路侧块螺钉结合悬臂梁技术提拉复位固定治疗II型齿状突骨折伴寰枢椎不稳，固定可靠，骨折愈合率高，植骨融合率高。临床应用具有操作简单、安全有效的优势。

Abstract: Objective: To review and analyze the clinical efficacy of posterior lateral block screw combined with cantilever beam technique for traction, reduction, and fixation in the treatment of patients with II-type odontoid process factures. Method: We analyzed the clinical data of 32 patients with Type II odontoid process fractures treated with posterior cervical lateral block screw combined with cantilever beam technique for traction, reduction, and fixation at our hospital from November 2015 to November 2022. Among them, 23 were male and 9 were female; Ages ranged from 24 to 65 years, with an average of 43.6 ± 13.1 years. There were 26 cases of traffic accident injuries and 6 cases of falls from height. Among these, 16 cases were Type IIa, 9 cases were Type IIb, and 7 cases were Type IIc. All cases presented with varying degrees of occipito-cervical pain and restricted mobility, with Visual Analogue Scale (VAS) scores ranging from 5 to 10 points, averaging 7.5 ± 1.3 points. Among them, 11 patients exhibited varying degrees of spinal cord nerve injury, including 7 cases graded as ASIA D and 4 cases graded as ASIA C; JOA scores ranged from 9 to 13 points, with an average of 11.4 ± 1.2 points. All patients underwent posterior lateral mass screw fixation combined with titanium cable suspension support traction reduction and fixation, along with interlaminar bone grafting. Results: All patients underwent surgery successfully, with no intraoperative vascular, spinal cord, or nerve injuries. All cases were followed up for 1~3 years, with no cases of internal fixation loosening or atlantoaxial posterior arch fracture during follow-up. The VAS scores at 1 week, 6 months, and the final follow-up were 3.9 ± 1.0, 1.3 ± 0.9, and 0.8 ± 0.7 points, respectively, all showing significant improvement compared to the preoperative score of 7.5 ± 1.3 points (P < 0.001). Among the 11 patients with concomitant spinal cord injury, all showed improvement at the final follow-up, with 9 (82%) experiencing a 1-grade improvement in neurological function and 2 (18%) experiencing a 2-grade improvement. The JOA scores at one week, six months, and the final follow-up were 13.7 ± 1.3, 15.6 ± 1.1, and 16.2 ± 0.6 points, respectively, all showing significant improvement compared to preoperative scores (P < 0.001). At the final follow-up, the atlantoaxial joint was well reduced, with no loosening or fracture of the screws, U-shaped rods, or titanium cables. At 6 months postoperatively, 17 cases of odontoid process fractures had healed, with a fracture healing rate of 53.13%; at 12 months postoperatively, 25 cases had healed, with a healing rate of 78.13%. At 18 months postoperatively, 29 cases had healed, with a healing rate of 90.62%. At 36 months postoperatively, 3 cases had not healed, with a non-healing rate of 9.38%, but all patients achieved good fusion with posterior bone grafting. Conclusion: The use of posterior lateral block screws combined with cantilever beam technology for traction, reduction, and fixation in the treatment of Type II odontoid process fractures with atlantoaxial instability results in reliable fixation, high fracture healing rates, and high bone graft fusion rates. This clinical application offers the advantages of simplicity, safety, and effectiveness.