摘要
目的：探讨C2—3后路钉棒固定联合枢椎棘突肌肉血管复合体移植治疗不稳定型Hangman骨折的临床疗效。方法：2014年9月～2015年8月，对7例不稳定型Hangman骨折患者行C2—3内固定椎间融合术，男5例，女2例，年龄27。62岁（平均43-12．7岁），HangmanⅡ型骨折6例，ⅡA型骨折1例。术前均行X线片、CT和MRI检查。7例患者均行C2—3后路椎弓根钉棒固定联合枢椎棘突肌肉血管复合体骨移植术。术后和随访时均行颈椎动力位X线片和CT检查观察骨折复位和愈合情况，术前、术后采用JOA（Japanese Orthopedic Asscciation）评分及轴性症状等级评估患者神经功能和症状。结果：所有患者均获得随访，随访时间为9～15个月，平均为10．5＋1．6个月。术后X线片和CT显示所有患者复位满意，随访期间无复位丢失、内固定失败及螺钉松动，动力位X线片未见失稳出现；末次随访CT示植骨块连续性骨小梁通过，达到骨性融合，骨性融合时间为5～10个月（7．1±1．3个月），术后1周和6个月时的JOA评分改善率分别为（23．1±10．5）％和（50．2±15．7）％。术后轴性症状3例为优，4例为良。结论：C2—3后路椎弓根钉棒固定联合枢椎棘突肌肉血管复合体骨移植治疗不稳定型Hangman骨折临床可行，能重建颈后肌群结构，减少轴性症状的发生。
Objectives： To assess the clinical outcomes of C2-3 posterior screw-rod fixation combined with C2 spinous process-muscle-vascellum complex transplantation for unstable Hangman fracture. Methods： The study included 7 cases of unstable Hangman fracture treated between September 2014 and August 2015. There were 5 males and 2 females whose age ranged from 27 to 62 years old（mean, 43±12.7 years old）. Six cases were diagnosed with Hangman Ⅱ fracture and one case was Hangman Ⅱ A fracture. X-ray, CT scan reconstruction and MRI were evaluated before operation. All the patients were treated with one stage C2-3 posterior screw-rod fixation combined with C2 spinous process-muscle-vascellum complex transplantation. Preoperative and postoperative Japanese Orthopedic Association （JOA） scores, the degree of axial symptom were recorded and compared. Results： All the patients were followed up. The follow-up time ranged from 9 to 15 months （mean, 10.5±1.6 months）. Postoperative cervical spine X-ray and CT showed that the cervical spine alignment was restored. The dynamic X-ray showed no instability of cervical spine. The time of bone fusion in CT scan ranged from 5 to 10 months （mean, 7.1±1.3 months）. The improvement rate of JOA scores at 1 week after operation of （23.1±10.5）% was significantly smaller than that at 6 months after operation of （50.2± 15.7）%. The results of axial symptom was satisfactory in 4 patients and acceptable in 3 patients. Conclusions： The C2-3 posterior screw-rod fixation combined with C2 spinous process-muscle-vascellum complex transplantation for unstable Hangman fracture is effective. This procedure can preserve muscle intact and cervical stability.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2016年第11期967-971,共5页
Chinese Journal of Spine and Spinal Cord
