Investigation Advancement Of Odontoid Fractures And The Analysis Of Clinical Treatment

Objective: To investigate the selection of odontoid fracture treatment and evaluation of its clinical efficacy.Methods: Retrospective analysis of clinical data and imaging information of 40 cases of odontoid fractures from February 2000 to November 2008 in our hospital, which treated with Halo-vest, posterior Apofix technique, anterior screw fixation technique .Referral and communication by follow-up analysis of odontoid fractures:the cervical spine activity, the rate of fracture healing, surgical complications, and spinal cord injury using Frankel functional classification and the Japanese Society of Orthopedic Surgery (JOA) score-criteria analysis the improvement of nerve function .Results: 40 cases in this group, referral and communication by way of follow-up 3 to 96 months, an average of 15.8 months. Halo-vest external fixator group of 26 cases, 26 cases of bone healing.According to Anderson - D'Alonzon type: 21 cases ofⅡtype, 5 cases ofⅢtype, there are no complications,such as skull screw loosening, loss,or pin tract skin infections. Posterior Apofix technique group of 6 cases, all of old odontoid fracture, of which 4 cases of typeⅡ, 2 cases ofⅢtype, no laminar extrusion folder, loose and connecting sleeve fracture, all bone blocks were bone integration. Neck rotation and flexion significantly limited, the average scope loss of cervical rotation is about 40%. Anterior odontoid screw fixation group of 8 cases, all fresh odontoid fractures, including 7 cases of typeⅡ, 1 cases ofⅢtype .there are no bone absorption and fragments ,no hollow screw loosening or broken and good cervical activity. X-ray shows: odontoid fracture line blurred or disappeared, fracture healing rate of 100%. With cervical spinal cord and nerve root injuries (JOA) to analysis the situation of spinal cord function improvement: postoperative improvement rate = (postoperative score - preoperative score) / (17 - preoperative score)×100%. The results show that postoperative improvement rate is 33.3% ~ 100%, with an average of 66.9%. Conclusion: Early diagnosis of odontoid fractures can avoid misdiagnosising and delay in treatment; combination in patients with fracture type, displacement of the situation, economic conditions, the choice of treatment programs, can achieve the desired clinical effect. Correct choice of surgical indications, adequate preoperative preparation and refinement of the surgical procedure and postoperative external fixation is an appropriate treatment of the key to success.