前路减压植骨融合及钛板固定治疗Hangman骨折  

Anterior fusion with the internal fixation for treatment of Hangman＇s fracture

作　　者：李忠海[1] 赵杰[1] 竺伟[1] 张海龙[1] 马辉[1] 王聪[1] 侯铁胜[1] 

机构地区：[1]第二军医大学附属长海医院骨科,上海200435

出　　处：《中华创伤骨科杂志》2010年第1期17-20,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨颈前路减压植骨融合及钛板固定治疗Hangman骨折的临床疗效。方法2004年6月至2008年12月共收治20例Hangman骨折患者，男14例，女6例；年龄35～62岁，平均49．2岁。根据Levine—Edwards分型标准：Ⅱ型10例，ⅡA型7例，Ⅲ型3例。所有患者术前均经颅骨牵引，14例行颈前路C2-3，椎间盘切除、植骨融合钢板固定术，6例行C，椎体次全切除、植骨融合钢板固定术。治疗前后根据国际脊髓损伤评分（ASIA）标准对患者进行感觉和运动评分，并对手术前后影像学资料进行比较分析。结果20例患者术后获7～51个月（平均25．6个月）随访，患者神经功能恢复良好，ASIA感觉评分术前、术后1个月及末次随访时平均分别为（145．2±25．6）、（166．2±31．5）、（212．2±33．2）分，三者比较差异均有统计学意义（P〈0．05）。ASIA运动评分术前、术后1个月及末次随访时平均分别为（53．3±15．2）、（68．5±18．7）、（87．3±21．3）分，三者比较差异均有统计学意义（P〈0．05）。术后X线片示6个月内植骨均获骨性融合，稳定性良好，无钢板及螺钉松动、断裂等并发症发生。结论颈前路减压植骨融合及钛板固定治疗不稳定Hangman骨折具有减压彻底、有效恢复生理前凸、植骨融合率高、能早期活动等优点，是一种较好的治疗方法。Objective To study clinical outcomes of anterior fusion with internal fixation for traumatic spondylolisthesis of the axis （Hangman＇s fracture）. Methods From June 2004 to December 2008, 20 patients with traumatic spondylolisthesis of the axis were treated operatively. They were 14 males and 6 females, aged from 35 to 62 years, with an average of 49.2 years. According to the classification system designed by Levine and Edwards, the radiological manifestations revealed type Ⅱ in l0 cases, type IIA in 7 cases and type m in 3 cases. All cases achieved anatomic reduction by skull traction before operation. Fourteen cases underwent anterior C2-3 disceetomy followed by insertion of a bone spacer for fusion and anterior plating. Six cases underwent anterior C3 subtotal vertebrectomy, strut graft insertion, and anterior plating. The sensation and motion of the patients were evaluated preand postoperatively according to ASIA scoring system. Results of X-ray, CT and MRI examinations were also measured and compared pre-and post-operatively. Results The average follow-up time was 25.6 （7 to 51 ） months. All bone grafts ac- quired stable fusion in 6 months, the neurological functions were restored satisfactorily, and no plates or screws broke or loosened. Conclusion Anterior fusion and the internal fixation is a good alternative method for treatment of instable Hangman＇s fracture, because it has advantages of complete decompression, a high rate of successful bony fusion and early ambulation.

关 键 词：枢椎 骨折 脊柱融合术 内固定器 

分 类 号：R686[医药卫生—骨科学]