摘要
目的探讨前路颈2-3复位融合内固定治疗Ⅱa、Ⅱ型Hangman骨折的临床疗效。方法回顾性分析我院2009-2013年收治的17例Hangman骨折患者,按Levine-Edwards分型Ⅰ型1例、Ⅱ型12例、Ⅱa型4例。术前脊髓损伤ASIA分级D级3例,其余为E级。5例患者术前行颅骨牵引复位。所有患者均采用前路颈2-3椎间盘切除n-HA/PA66椎间融合器植骨、uniplate钛钉板内固定术手术治疗。根据VAS评分标准、ASIA标准分级及影像学资料,进行比较分析。结果所有患者均获得颈2-3椎间骨性融合,无明显并发症发生,术后神经功能改善,由D级恢复到E级。15例患者颈部疼痛消失,2例患者残留慢性颈部疼痛。VAS评分术前、术后1周及末次随访时平均分别为(3.90±0.62)、(1.32±0.80)、(0.57±0.94),结果比较,有统计学意义(P<0.05)。术前、术后1周及末次随访时颈2、3成角大小及颈2椎体前移距离平均分别为(5.41±4.47)°、(3.17±1.50)mm;(2.05±1.95)°、(1.00±0.79)mm;(2.05±2.19)°、(1.05±0.74)mm,术后1周与术前比较有统计学意义(P<0.05),末次随访与术后一周比较,差异无统计学意义(P>0.05)。结论前路颈2、3复位融合内固定治疗Ⅱa、Ⅱ型Hangman骨折可获得较好的临床疗效,但术前应严格把握手术适应症。
Objective To investigate the clinical outcomes of anterior C2-3 fusion and internal fixation in the treatment of type Ⅱa, Ⅱ Hangman fractures. Methods There were 17 patients with Hangman fracture,from 2009 to 2013 in our hospital were reviewed retrospectively. Accord- ingto the classification system designed by Levine and Edwards,type I in 1 ease , type Ⅱ in 12cases,typeIIa in 4 cases. According to American spinal injury association（ASIA） system,3 cases had spinal injury before operation were at grade D,the other patients were at grade E. Part of these eases underwent skull traction for close reduction,then treated with anterior C2-3 discectomy followed by insert n-HA/PA66 interbody fusion cage for fusion and anterior plat fixation. The visual analogue seale（VAS）,ASIA system and the imaging data were used for comparative analysis. Results All of 17 patients were followed up for 12 months to 3 years. All bone grafts acquired stable fusion or bone healing with no C2-C3 instability,there was no obvious postoperative eomplieations. The neurological functions were restored satisfactorily,ASIA score from D to E. The neck pain of 15 patients was relieved, but 2 patients residual neck pain after anterior surgeries. Conclusion Anterior C2-3 reduction, fusion and internal fixation can recover the normal tract of cervical vertebra immediately achieve good clinical efficacy in Hangman fractures,but the operation indication must be strictly grasped preoperatively.
出处
《颈腰痛杂志》
2015年第4期283-287,共5页
The Journal of Cervicodynia and Lumbodynia
关键词
颈椎
HANGMAN骨折
前路
内固定
cervical vertebra
Hangman＇s fracture
anterior
internal fixation.
