Résumé
Ce travail porte sur une étude rétrospective du vissage antérieur chez 45 patients présentant une fracture de l'odontoïde. La population comportait 36 hommes et 9 femmes dont les fractures étaient du type II dans 35 cas et du type III dans 10 cas. II y avait 34 fractures fraîches et 11 cas anciens. Les complications neurologiques ont été retrouvées chez 16 patients et 18 présentaient des lésions associées. Tous les patients ont bénéficié d'une ostéosynthèse par une seule vis. L'immobilisation postopératoire, le port d'un collier et le traumatisme chirurgical ont été réduites au minimum. Chez l'un des patients la vis est sortie de l'odontoïde et une fusion postérieure immédiate s'est avérée nécessaire. Le taux global de consolidation a été de 93% (41 fractures sur 44). Le délai de consolidation a été en moyenne de 5.2 mois. On a relevé deux retards de consolidation et trois pseudarthroses dont les causes ont été une pseudarthrose préopératoire avérée, une ostéoporose sévère et une situation inadéquate de la vis. Parmi les 11 lésions anciennes, huit ont consolidé. 96% des patients ont présenté une récupération neurologique. Le taux global des complications a été de 11%, regroupant une fausse route de vissage, une blessure de la paroi postérieure du pharynx et trois pseudarthroses. Selon les évaluations cliniques, la rotation de la tête a été préservée chez 90% des patients ayant consolidé. Le vissage antérieur est un traitement optimal pour les fractures fraĩches de type II et III de l'odontoïde, permettant un fort pourcentage de consolidation, la préservation de la mobilité du segment C1–C2 et un traumatisme chirurgical minime. II peut être même appliqué à certaines lésions anciennes. Une sélection précise du patient, sa densité osseuse, le temps écoulé depuis l'accident, une réduction préopératoire anatomique et une méthode chirurgicale méticuleuse faisant appel à un amplificateur de brillance performant, sont essentiels pour éviter les complications et les pseudarthroses.
Summary
Clinical results of anterior screw fixation in 45 patients with odontoid fractures were reviewed retrospectively. The patients were 36 males and 9 females, with fractures classified as 35 type II and 10 type III. There were 34 fresh and 11 old fractures. Neurological complications were present in 16 patients and 18 had associated injuries. All patients underwent single screw fixation. Postoperative immobilization, external support, and surgical trauma were minimal. In one patient a screw extruded from the dens and immediate posterior fusion was necessary. The overall rate of fracture union was 93% (41 out of 44 fractures). Fracture resolution averaged 5.2 months. There were two delayed unions and three nonunions, the causes of which were preoperatively established nonunion, severe osteoporosis, and inaccurate screw placement. Out of 11 old cases, 8 went on to union. Ninety-six percent of the patients recovered neurologically. The overall complication rate, including a misplaced screw, a retropharyngeal wall injury, and three nonunions, was 11%. Head rotation was preserved in 90% of the patients with fracture union according to clinical measurements. Anterior screw fixation is an excellent treatment for fresh type II and cephalad type III odontoid fractures, carrying a high union rate, preservation of the C1–2 motion segment, and minimal surgical trauma; it can be applied even to some old cases. Precise patient selection in regard to patient age, bone density, and time elapsed since injury as well as preoperative anatomical reduction and meticulous surgical technique with fine fluoroscopy are essential to avoid complications and nonunions.
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Chiba, K., Fujimura, Y., Toyama, Y. et al. Anterior screw fixation for odontoid fracture: clinical results in 45 cases. Eur Spine J 2, 76–81 (1993). https://doi.org/10.1007/BF00302707
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DOI: https://doi.org/10.1007/BF00302707
Mots-clés
- Fractures de l'odontoïde
- Fracture de la dens
- Vissage antérieur
- Pseudarthrose de l'odontoïde
- Lésion du rachis cervical supérieur