One Herbert Double-Threaded Compression Screw Fixation of Displaced Type II Odontoid Fractures

單支雙縲紋加壓鋼釘治療的外科治療第二型齒狀突移位骨折

張國華(Kai-Wha Chang)；林進盛(Gen-Zen Lin)；劉以文(Yee-Wen Liu)；梁鉑鈴(Po-Ling Liang)

odontoid fracture ； compressive osteosynthesis ； double-threaded compression screw

Journal of Orthopaedic Surgery Taiwan

10卷1期（1993 / 03 / 01）

129 - 138

英文

外科治療第二型齒狀突移位骨折通常是以傳統第一、二頸椎融合術治療。而以直接鋼釘固定骨折則可保留頸椎轉動功能，一般認為第二型齒狀突移位骨折不能完全復位，是不能以直接鋼釘固定治療的。七位可完全復位的第二型齒狀突移位骨折病患(第一組)以單支4.5mm雙縲紋加壓鋼釘固定骨折。五位僅可部份復位的第二型齒狀突移位骨折病患(第二組)，是以單支3.0mm雙縲紋加壓鋼釘固定骨折。全部病患都經過一年的追蹤，沒有大的併發症發生。第一組病患沒有喪失復位。第二組病患有平均0.8mm的向前位移和5度的前傾位移喪失。所有的骨折均愈合，平均愈合時間為4.1個月。十位病患的頸部活動功能的療效沒有差別。我們的結果顯示閉鎖式復位及單支雙縲紋加壓鋼釘固定骨折是一理想治療可完全復位或部份復位的齒狀突第二類型移位骨折的方法。近百分之百的愈合率及保留頸部旋轉功能是此法的最大優點。然而手術之技巧及禁忌症也都應特別注意.

Surgical treatment of Type II odontoid fractures(OFs II) has usually been carried out by C1-C2 arthrodesis rather than by fracture fixation. An alternative treatment of direct screw fixation is used to treat the fractures for preservation of atlantoaxial rotation. OFs II that cannot be completely rediced by closed means is generally believed to be a contraindication for anterior screw fixation. Seven patients (Group I) with displaced OFs II that could only be partially reduced were treated with fracture fixation by one 3.0 mm double-threaded compression screw. All patients had a minimum of 1year follow-up. No major complications occurred. No loss of reduction occurred in Group I patients. Loss of reduction of averaged 0.8 mm anterior displacement and 5° anterior angulation occurred in Group II patients. The overall rate of fracture union was 100%, and fracture resolution averaged 4.1 months. Then patients presented a normal range of cervical rotation and there were no difference of preservation of cervical rotation between the two groups. Our results suggest that close reduction and compressive osteosynthesis by one double-threaded compression screw is an optimal method of treatment for displaced OFs II that can be completely reduced as well as some of the cases that can only be partially reduced. One hundred percent rate of fracture union and preservation of cervical rotation are the major advantages of this method.However, significane complications have been reported by other authors. The use of meticulous surgical technique is mandatory, and contraindications should be respected.