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| MA Xiangyang,YANG Jincheng,ZOU Xiaobao.Clinical treatment options and results of the old type Ⅱ odontoid fracture[J].Chinese Journal of Spine and Spinal Cord,2017,(1):37-42. |
| Clinical treatment options and results of the old type Ⅱ odontoid fracture |
| Received:October 24, 2016 Revised:December 21, 2016 |
| English Keywords:Type Ⅱ odontoid fracture Old fracture Treatment options Clinical results |
| Fund:广东省省级科技计划项目（编号：2015B020233013） |
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| English Abstract: |
| 【Abstract】 Objectives: To investigate the clinical results and treatment options of the old type Ⅱ odontoid fracture. Methods: From June 2010 to June 2015, 77 patients(mean age, 37.0±14.5 years; range, 16 to 65 years) with old type Ⅱ odontoid fracture, with the time of injury exceeding 3 weeks, including 52 males and 25 females, were treated by cannulated odontoid screw fixation(5 cases), C1-C2 screw-rod fixation(6 nonfusion cases and 40 fusion cases) or transoral atlantoaxial reduction plate(TARP) fixation(26 cases) under general anesthesia according the fracture time period and individual conditions. American Spinal Injury Association(ASIA) and Japanese Orthopaedic Association(JOA) score system were used to evaluate the surgical outcomes. Before operation, 32 patients were in grade D, and 45 cases were in grade E. Preoperative JOA score was 12.9±2.4. Patients were followed up and performed X-ray and CT to investigate the union, reduction and fusion. Results: All operations were successfully performed without neurovascular injury. The incidence of neck pain and extremity anesthesia or asthenia of all cases decreased in different degrees. According to ASIA grading system, 20 cases improved from D to E after surgery, and the other cases remained no change postoperatively. JOA score improved from preoperative 12.9±2.4 to 15.2±1.2 after surgery, the difference had statistical significance(t=-12.211, P=0.000). All cases were followed up with an average time of 27.0±9.6 months (range, 3-36 months). Odontoid fracture of 4 cases with cannulated odontoid screw fixation and 6 cases with screw-rod nonfusion fixation had a reduction and bone union on radiographs, except that 1 case of anterior odontoid screw fixation got a fibrous union. Atlantoaxial dislocation in 66 cases with anterior or posterior fusion fixation attained a reduction and solid bone fusion. Conclusions: The treatment methods of the old type Ⅱ odontoid fracture should be selected according to the fracture time period and individual conditions to acquire satisfying clinical results. |
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