摘要目的 分析颈前路加压螺钉内固定治疗Ⅱ型齿状突骨折失误的原因及对策.方法 分析2002年4月至2010年7月在C型臂X线机监视下行前路加压螺钉内固定治疗中出现失误的15例新鲜Ⅱ型齿状突骨折患者资料,男10例,女5例;年龄22～65岁,平均37岁.对术中发生的失误进行分析,探究其原因,并总结经验寻找避免再次失误的办法.结果 所有患者术后获6～47个月(平均13.4个月)随访.骨折均获良好愈合,愈合时间为12～34周,平均14.5周,无其他严重不良并发症发生.颈前路单枚空心螺钉治疗齿状突骨折术中失误可分为以下3种类型:①术中导针跟进穿透齿状突进入颅腔3例,其中1例因延髓损伤死亡;②骨折移位导致复位不良5例;③多次更改导针方向引起钉道扩大而导致螺钉位置及固定不良7例.结论 颈前路单枚空心螺钉治疗Ⅱ型齿状突骨折术,中失误原因多由术者末在术前仔细阅读X线片即进行手术评价,以及对器械的了解不充分所致,少数是由于术中意外导致,这些失误大多可以通过术前仔细准备和术中精细操作而避免.

abstractsObjective To analyze intraoperative mismanagements in anterior single-screw fixation of odontoid fractures.Methods From April 2002 to July 2010, intraoperative mismanagements happened in the treatment of 15 cases of fresh odontoid fracture with anterior single-screw fixation under C-arm fluoroscopy.They were 10 men and 5 women, aged from 22 to 65 years (average, 37 years).All the fractures were Anderson-D' Alonzo type Ⅱ.The mismanagements were characterized to find out their reasons.Results The mean follow-up time was 13.4 months (range, 6 to 47 months).All the fractures healed in an average of 14.5 week (range, 12 to 34 weeks) after operation, no severe complications were found.The intraoperative mismanagements could be elassified into 3 kinds.In the first kind, the guide pin was driven through the odontoid bone into the cranial cavity in 3 cases, resulting in one death due to serious injury to the medullary bulb.In the second kind, malreduction happened in 5 cases due to intraoperative displacement of the fracture.In the third kind, poor position and fixation of the screw happened in 7 cases because of enlargement of the screw canal after repeated correction of the guide pin direction.Conclusions The intraoperative mismanagements in anterior single-screw fixation of odontoid fractures were mostly caused by careless surgeons who made their operative assessments and plans before they read the X radiographs of their patients carefully or before they had been familiar with the operative instruments.Secondly, some mismanagements were caused by intraoperative accidents, most of which, however, could have been avoided by careful preoperative preparation and meticulous operative maneuvers.