ODONTOİD FRAKTÜR YÖNETİMİ: KLİNİK DENEYİM

Amaç Kliniğimize başvuran odontoid kırıklı hastalara uyguladığımız tedavi yaklaşımlarını literatür eşliğinde sunmayı amaçladık. Gereç ve Yöntem Kliniğimize başvuran odontoid kırıklı 18 hasta retrospektif olarak değerlendirildi. Hastaların 6’sı kadın, 12’si erkek ve yaş ortalamaları 45,5 (16-87) idi. 7 hastada Tip 1, 4 hastada Tip 2, 7 hastada Tip 3 kırık tespit edildi. Tip 1 kırık tespit edilen hastaların %86’sı (n=6), tip 3 kırık tespit edilen hastaların %57’si (n=4) konservatif takip edilirken, tip 2 kırıkların tümüne anterior odontoid vidalama, tip 3 kırıklı 1 hastaya posterior artrodez uygulandı. Konservatif tedavi edilen hastaların 6’sında Halo-Vest, 3’ünde Philadelphia boyunluk, 2’sinde sterno-oksipito-mandibüler immobilizasyon (SOMİ) kullanıldı. Bulgular Konservatif takip edilen 11 hastadan 7’sinde (%64) füzyon izlenirken, 4’ünde (%36) füzyon gelişmemesi üzerine cerrahi planlandı. Hastalardan 2’si şikayetlerinin olmaması nedeni ile cerrahiyi kabul etmedi. Anterior cerrahi yapılan 1 hastada vida malpozisyonu görülerek posterior oksipitoservikal füzyon yapıldı. Sonuç Odontoid kırıklarında tedaviye karar verirken fraktür tipi ve hasta yaşı dikkate alınmalıdır. Cerrahi teknik belirlenirken klinik iyileşmenin yanısıra füzyon oranı da önemlidir. Anterior vidalama hareketin daha iyi korunabilmesi için genç hastalarda; mekanik yetmezlikle karşılaşmamak ve diğer komplikasyonları en aza indirebilmek amacıyla posterior füzyon ileri yaşlı hastalarda tercih edilmelidir. Ancak halen uygun tedavi stratejisi net değildir.

Anahtar Kelimeler:

odontoid, odontoid vidalama, konservatif yaklaşım, C1-C2 artrodez

ODONTOID FRACTURE MANAGEMENT: CLINICAL EXPERIENCE

Objective We aimed to report the treatment approaches we administered to the patients admitted to our clinic for odontoid fracture, accompanied by literature. Material and Methods Eighteen patients with odontoid fracture who admitted to our clinic were evaluated retrospectively. Six patients were female, twelve patients were male and the mean age was 45,5 (16-87). Type 1 fracture in 7 patients, Type 2 fracture in 4 patients and Type 3 fractures in 7 patients were determined. As 86% of the patients with type 1 fracture, and 57% of the patients with type 3 fracture were treated conservatively, all patients with type 2 fracture treated with anterior odontoid screw and in 1 patient with type 3 fracture posterior arthrodesis was performed. Six of the conservatively treated patients used Halo-Vest, 3 of them used Philadelphia cervical collar, and 2 of them used sterno-occipito-mandibular immobilizer (SOMI). Results Fusion was occurred in 7 patients (64%) of 11 patients, who treated conservatively, and in the 4 patients (36%) surgery was planned as non-fusion was occurred. Two of these patients with no symptoms did not accept surgery. In one patient, with anterior surgery, posterior occipitocervical fusion was done as screw malposition was seen. Conclusion In decision making of the odontoid fractures, type of the fracture and age of the patient should be considered. As deciding the surgical technique beside clinical improvement, fusion rate is also important. In the elder patients anterior screwing should be preferred to conserve mobility; in the older patients posterior fusion should be preferred not to have mechanical deficiency and to minimize the other complications. However appropriate treatment strategy is still not clear.

Keywords:

odontoid, odontoid screwing, conservative approach, C1-C2 arthrodesis,

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