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題名 | Management of Type Ⅲ Dens Fracture=第二頸椎齒狀突第三型骨折之治療分析 |
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作者姓名(中文) | 雷大雅; 李石增; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 31:6 民87.11-12 |
頁次 | 頁362-367 |
分類號 | 416.291 |
關鍵詞 | 第二頸椎齒狀突; 骨折; Type Ⅲ dens fracture; Halo-vest; Halifax clamp; |
語文 | 英文(English) |
中文摘要 | 第二頸椎齒狀突第三型骨折傳統上主張以頭圈外固定器固定三至六個月治療,我們在29例病患中,18例接受內固定手術,另外10例以傳統外固定法治療,結果所有29例恢復情形良好。因為頭圈外固定器雖然安全有效,但是病患要忍受三至六個月的痛苦,而手術內固定危險性低並可早日回復正常生活或工作,所以我們主張除非病患有嚴重之內科疾病致麻醉或手術危險,否則手術內固定是較佳之治療方法。 |
英文摘要 | External immobilization with a halo vest is the traditional treatment of choice for type Ⅲ fracture of the odontoid process of C2 (dens). Wiht the evolution of new operative techniques and fixation devices, however, this policy is being questioned. We retrospectively reviewed a series of patients treated by operative and nonoperative methods. The series included 22 men and 7 women and the most frequent cause of injury was traffic accidents. Twenty of these patients had normal motor power at the time of admission. Five had flaccid quadriplegia and one had flaccid quadriplegia combined with respiratory failure. Eighteen patients underwent posterior C1-C2 fusion, 17 with the Halifax clamp and one with wire by the Brooks method followed by 8 weeks of immobilization with a Philadelphia collar.Ten other patients received external immobilization with a halo vest for 12 to 16 weeks. One patient died before treatment. All patients achieved fusion and good stability at 6 months follow-up There were patients with wound infection in the immediate post-operative period. One side of the Halifax clamp was found lossened during the follow-up period for 1 patient, although he eventually had fusion of the fractured dens. In addition, pin-hole infection was found in 2 of the halo-treated patients. Overall, there were no major complications in either the operative or non-operative patients. Both extenal fixation with the halo vest and internal fixation are safe and effective for treating type Ⅲ dens fractures. We now prefer internal fixation because the surgical risk is low and it avoids patient discomfort inherent with the halo vest. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。