目的 比较前弓分离移位的Gehweiler Ⅲa型寰椎骨折非手术与手术治疗的疗效.方法 回顾性分析自2013-08-2021-10收治的35例前弓分离移位Gehweiler Ⅲa型寰椎骨折,其中24例采用Halo支具固定治疗(Halo支具组),11例行寰椎或寰枢椎后路螺钉内固定治疗(手术治疗组),比较两组患者骨折愈合情况,分析骨折移位程度对骨折愈合的影响.随访观察Halo支具治疗组支具拆除后骨折愈合和骨折不愈合患者的疼痛VAS评分、颈椎功能障碍指数(Neck disability index,NDI)及寰枢椎相对旋转度(Rotating angle of atlas on dentate,RAAD).结果 所有患者均获得随访,随访时间24～40周,平均33.3周.所有患者后弓均获得骨性愈合,但总体前弓骨折愈合率为71.4％,其中手术治疗组9例(81.8％)获得前弓骨性愈合,Halo支具组16例(66.7％)获得前弓骨性愈合,手术治疗组前弓骨折愈合率高于Halo支具组.Halo支具组根据支具拆除后是否获得骨性愈合分为愈合组(n=16)和不愈合组(n=8),不愈合组寰椎侧块分离移位明显大于愈合组(P＜0.05).支具拆除后1个月愈合组颈部疼痛VAS评分、NDI指数、RAAD均较不愈合组改善明显,差异有统计学意义(P＜0.05);支具拆除后3、6个月,愈合组RAAD优于不愈合组,差异有统计学意义(P＜0.05),但两组颈部疼痛VAS评分、NDI指数差异无统计学意义(P＞0.05).结论 移位程度较大的Gehweiler Ⅲa型寰椎骨折出现不愈合的风险较高,而手术治疗较Halo支具固定的骨折愈合率更高.如果Gehweiler Ⅲa型寰椎骨折前弓骨折移位较大,且患者对旋转功能要求高,则建议积极手术治疗.
Comparison of effects between non-surgical and surgical treatments for Gehweiler Ⅲa atlas fractures with anterior arch separation and displacement
Objective To compare the effects between non-surgical and surgical treatment of Gehweiler Ⅲ a atlas fractures with anterior arch separation and displacement.Methods Thirty-five cases of Gehweiler Ⅲ a atlas fractures with anterior arch separation and displacement treated from August 2013 to October 2021 were retrospectively analyzed.Twenty-five cases were treated with Halo brace fixation,and eleven cases with posterior atlas or atlantoaxial screw fixation.The fracture union rates of two groups were compared and the impact of displacement on fracture union was analyzed.The VAS score,neck disability index(NDI)and rotation angle of atlas on dentate(RAAD)were observed in patients with fracture union and nonunion groups after Halo brace fixation removal.Results The mean followed-up was 33.3(range,24-40)weeks.All patients achieved bone union of the posterior arch.The overall anterior arch union rate was 71.4％,including 9 cases(81.8％)in the surgical treatment group and 16 cases(66.7％)in the Halo brace group.The union rate in the surgical treatment group was higher than that in the Halo brace group.The patients were divided into union group(n=16)and nonunion group(n=8)according to whether bone union was achieved after brace removal.The displacement of atlas lateral mass in nonunion group was significantly greater than that in union group(P＜0.05).One month after removal,the VAS score,NDI index and RAAD in the union group were significantly im-proved compared with those in the nonunion group(P＜0.05);At 3 and 6 months after the brace removal,RAAD in the union group was better than that in the nonunion group(P＜0.05),but there was no significant difference in VAS score and NDI index between the two groups(P＞0.05).Conclusion Gehweiler Ⅲ a atlas fractures with greater displacement has a higher risk of nonunion,and the fracture union rate of surgical treatment is higher than that of Halo brace fixation.For the patients with the Gehweiler Ⅲ a atlas fractures and a large displacement of the anterior arch,and high requirements for rotation function,active surgical treatment is recommended.
Fracture of atlasAnterior arch separation and displacementInternal fixationGehweiler typing
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