两种不同手术入路治疗不稳定Hangman骨折的比较  

Comparison of two approaches in the treatment of unstable Hangman's fractures

作　　者：李金泉[1] 徐皓[1] 姚晓东[1] 唐焕章[1] 陈建梅[1] 王万宗[1] 

机构地区：[1]南京军区福州总医院骨科,福州350025

出　　处：《中国矫形外科杂志》2010年第4期280-283,共4页Orthopedic Journal of China

摘　　要：[目的]比较颈后路多节段椎弓根螺钉内固定术与颈前路钢板内固定术两种手术方法治疗不稳定Hangman骨折的临床疗效。[方法]32例不稳定Hangman骨折患者,其中男21例,女11例,年龄17～65岁,平均43.4岁。按Levine-Edwards分类,其中Ⅱ型骨折15例,ⅡA型骨折14例,Ⅲ型骨折3例。脊髓损伤按Frankle分级:D级4例,E级28例。所有患者受伤至手术时间1～15 d,平均5 d。采用颈后路多节段椎弓根螺钉内固定术治疗18例,颈前路钢板内固定术治疗14例,对两组患者的手术时间、术中出血量、手术并发症、骨折愈合情况及脊髓功能恢复情况进行比较分析。[结果]两组在手术时间[颈后路椎弓根螺钉内固定组平均(121±20)min、颈前路钢板内固定组平均(116±13)min]、术中出血量[颈后路椎弓根螺钉内固定组平均(360±25)ml、颈前路钢板内固定组平均(320±21)ml]、骨折愈合情况[颈后路椎弓根螺钉内固定组均获骨性愈合(无畸形愈合)、颈前路钢板内固定组均获骨性愈合("鹅颈"畸形1例)]及脊髓功能恢复情况方面差异无统计学意义(P>0.05);手术并发症[颈后路椎弓根螺钉内固定组出现1例(静脉丛损伤1例)、颈前路钢板内固定组出现6例(喉上神经损伤4例、颈部切口血肿1例、食管损伤1例)]方面差异有统计学意义(P<0.05)。[结论]颈后路多节段椎弓根螺钉内固定术是治疗不稳定Hangman骨折较理想的方法。[Objective]To compare the method and outcome for unstable Hangman＇s fractures through posterior pedicle screw poly-segmental fixation and anterior cervical fusion and plate fixation.[Method]There were 32 patients with unstable Hangman＇s fractures,including 21 males and 11 females,aged from 17 to 65 years with an average of 43.4 years.According to the classification system designed by Levine and Edwards,they were divided into type Ⅱ（n=15）,type ⅡA（n=14）and type Ⅲ（n=3）.According to Frankel scale,graded as spinal injury D（n=4）and E（n=28）.The time from injury to the index operation was from 1 to 15 days（mean,5 days）.Eighteen cases of unstable Hangman＇s fractures were treated with posterior pedicle screw poly-segmental fixation and 14 cases through anterior cervical fusion and plate fixation.The surgical time,blood loss,complication,union and neurological function were compared.[Result]The surgical time was（121±20）min for posterior pedicle screw fixation group,and（116±13）min for anterior cervical fusion and plate fixation group.And the blood loss was（360±25） VS（320±21）ml.All the cases in the posterior pedicle screw fixation group achieved bony fusion without deformity.In the anterior cervical fusion and plate fixation group,all cases achieved bony fusion with one case of ＂goose neck＂ deformity.Neurological function between the two groups showed no statistical different significance（P〉0.05）.One case developed hemorrhage of venous plexus in the posterior pedicle screw fixation group.And complications occurred in 6 cases（4 of superior nerve injury,1 of intra-incision hematoma and 1 of esophageal injury）.There were significant differences between 2 groups（P〈0.05）.[Conclusion]Posterior pedicle screw poly-segmental fixation is an ideal method for unstable Hangman＇s fractures.

关 键 词：HANGMAN骨折 枢椎 椎弓根螺钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]