不稳定性Hangman骨折前路重建颈椎稳定的手术治疗  

Antrior reconstuction surgical treatment for instable Hangman's fracture

作　　者：郭庆翔 唐建华 刘晓岚[2] 

机构地区：[1]广东省从化市中心医院,广东从化510900 [2]湖南省郴州市第一人民医院,湖南郴州423000

出　　处：《赣南医学院学报》2012年第3期403-405,共3页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:探讨前路颈椎前、中柱重建治疗不稳定性Hangman骨折的疗效及应用价值。方法:对收治的14例Ⅱ型、Ⅱa型及Ⅲ型Hangman骨折病例均行前路前、中柱重建钢板内固定术,其中5例行椎间植骨融合前路锁定钢板内固定术;2例行C3椎体次全切钛网重建锁定钢板内固定术(其中1例为后路钉棒固定失败的补救手术);7例行椎间钛网重建锁定钢板内固定术,术后进行9～24月(平均18个月)随访。结果:术后症状明显恢复。全部病例颈椎生理前凸及解剖序列得到完全恢复,C2骨折线模糊,其中1例C2/3稍过伸位固定,术后6个月植骨融合率达到100%,无内固定系统松动、断裂及钛网下沉高度丢失等现象。结论:应用颈椎前路手术重建颈椎前、中柱锁定钢板内固定术治疗不稳定性Hangman骨折具有可获得术后上颈椎即刻稳定,并在恢复颈椎生理前凸及解剖序列上具有显著的优势,能有效维持理想的复位,获得牢靠的生物学稳定,更适合难复位型Hangman骨折的治疗,是一种理想的治疗不稳定性Hangman骨折的有效方法。Objective： To evaluate the effects and application by anterior cervical reconstuction for the treatment of instable Hangrnan＇s fractures. Methods ： 14 patients with Hangman＇s fracture of type Ⅱ or Ⅱ a or Ⅲ all were treated by anterior fusion and internal fixation under column reconstruction with TiMesh and locking plate fixation between Octobor 2005 and Octobor 2009,5 eases of anterior interbody fusion; 2 routine by C3 anterior subtotal cutting and TiMesh reconstruction and locking plate fixation （ including one ease with remedial surgery for the failure of posterior screw fixation） ; 7 cases of anterior interbody reconstruction with TiMesh reconstruction and locking plate fixation. All patients were followed up for 9 to 24 months （ mean 18 months）. Results ： Clinical symptoms were relieved in all cases after operation. A stable bony fusion was achieved in all cases postoperatively. There were not only no broken or loosening , but also no TiMcsh sinking and in- terbody height lossing. But one of cases was fixed slightly hyperextended. Conclusion： For patient with instable Hangman fracture, anterior fusion and internal.fixation under column reconstruction with TiMesh and locking plate fixation offers an immediate stability and a high rate of successful bony fusion, maintaining the desired reduction, and renewing cervical lordosis and anatomical sequence,which has more significant advantages, and is more suitable for Hangman＇s fracture with hard reseted. So the surgical management and results of anterior column reconstruction is a perfect method to treating the instable Hangman＇s fractures.

关 键 词：HANGMAN骨折 不稳定 前路重建术 

分 类 号：R687.32[医药卫生—骨科学]