摘要
目的通过手术与非手术治疗比较,探讨椎弓根及侧块螺钉内固定治疗不稳定性Hangman骨折的技术操作要领和临床疗效。方法从1999年1月～2005年7月共收治36例不稳定性Hangman骨折,根据Levine-Edwards分型:15例颅骨牵引,21例实施后路椎弓根及侧块螺钉内固定术(C2,3融合10例,C2-4颈融合11例)。暴露C2,3或C2-4后方结构,取C2侧块中点为进钉点,一般为向头端倾斜20°～30°,向内倾斜25°～35°。对于C3、C4采用外倾斜35°～40°,与椎体关节面平行。所有操作均在C型臂X线机透视下完成。结果术后所有患者随访5～28个月,平均18个月。15例颅骨牵引者6例丢失复位位置,21例椎弓根螺钉内固定术者2例内固定松动,余均获骨性愈合,无颈椎功能受限。结论经C2,3、C2-4后路椎弓根及侧块螺钉内固定术是治疗不稳定性Hangman骨折的一种有效方法,达到复位固定和早期康复的目的,但两术式无明显差别。
Objective To investigate the technique and clinical effects of pedicle screw fixation in treatment of unstable Hangman＇s fractures in comparison with the conservative managements. Methods From January 1999 to July 2005, 36 patients with unstable Hangman＇s fractures were treated in our department, Based on Levine-Edwards classification, 15 of them were treated with skull traction, and others with internal fixation with posterior pedicle screws （C2, 3 fusion in 10 cases and C2-4 fusion in 11 cases）. After a posterior midline incision and clear exposure of posterior structure, the C2 screw was inserted through the center of the posterior aspect of lateral mass, inclining usually 20° to 30° towards the head of the transverse plane and 25° to 35° inwards to the medial incline of the sagittal plane. For C3, C4 screw insertion, the drilling was parallel to the joint plane of the relevant vertebra and inclined 35° to 40° outwards to the medial incline of the sagittal plane. The whole procedure was performed under the monitoring of C-arm screen for safety and accuracy. Results A mean follow-up time was 18 months （5 to 28 months）. 6 cases treated by skull traction lost their anatomic reduction. Of the 21 cases treated by the pedicle screw fixation, 2 had loosened internal fixation but 19 experienced no screw loosening and their fractures were cured entirely without limited function of the cervical vertebra. Conclusions In treatment of unstable Hangman＇s fractures, C2, 3 or C2-4 pedicle screw fixation is an effective method to achieve rigid reduction and early rehabilitation. However, there is no remarkable difference between C2, 3 fusion and C2-4 fusion.
出处
《中华创伤骨科杂志》
CAS
CSCD
2006年第2期135-138,共4页
Chinese Journal of Orthopaedic Trauma
关键词
枢椎
骨折
骨螺丝
骨折固定术
内
颅骨牵引
Axis
Fracture
Bones screws
Fracture fixation, internal
Skull traction
