Formation mechanism and surgical choice of teardrop fracture of the axis / 中华创伤杂志

ABSTRACT

Objective To discuss the formation mechanism of teardrop fracture of the axis and observe the clinical efficacy of anterior or posterior induction operation according to the fracture type.Methods Thirteen patients with teardrop fracture of the axis treated from May 2001 to October 2010 were involved in the study.There were 10 males and 3 females,at age range of 18-55 years (mean,35.5 years).Four patients were combined with cervical spinal cord injury (one patient with grade C and two with grade D according American Spinal Injury Association,ASIA).Injury causes included traffic injury in 11 patients and fall from height in two.After admission,the anteroposterior,lateral and mouth X-ray films,spiral CT sagittal reconstruction and MRI examination of the cervical vertebra were performed in all the patients.According to the injury mechanism,there were 10 patients with extension fractures treated with C2,3 intervertebral bone fusion and internal fixation through submandibular retropharyngeal approach and three with flexion fractures treated with posterior C2,3 intervertebral bone fusion and pedicle screw fixation.The clinical efficacy was also observed. Results All patients received complete exposure and effective reduction and fixation.The average time of anterior exposure and posterior exposure was 77 minutes and 125 minutes,respectively.No surgical complications occurred.All patients were followed up for 9-34 months (mean,13 months).Reexamination at four months after operation displayed bone healing in all patients.There was no lessening or breakage of the internal fixators.The spinal function of three patients with ASIA grade D injury and that of one patient with ASIA grade C injury recovered to normal at postoperative 1.5 and 6 months respectively. Conclusion The surgical approaches for teardrop fracture of the axis developed in the light of the fracture formation mechanism are beneficial and safe.