颈前路减压并桥形椎间锁定融合器内固定术治疗Ⅱ型及Ⅱa型Hangman骨折  

Anterior cervical decompression with double-way connection intervertebral fusion device implanta-tion for type II or type II a Hangman fracture

作　　者：曹贵君[1] 孟纯阳[1] 张卫红[1] 孔祥清[1] 张聪[1] 

机构地区：[1]济宁医学院附属医院脊柱外科,272000

出　　处：《中华创伤杂志》2016年第5期401-405,共5页Chinese Journal of Trauma

基　　金：济宁市科技计划（医药卫生）[济科字（2015）57号

摘　　要：目的探讨颈前路减压并桥形椎间锁定融合器（ROI-C）内固定术治疗Ⅱ型及Ⅱa型Hangman骨折的临床疗效。方法回顾性分析自2011年2月至2014年3月14例行颈前路ROI-C置入治疗的Ⅱ型及Ⅱa型Hangman骨折患者。其中男11例，女3例；年龄22～46岁，平均26．4岁。致伤原因：交通伤9例，坠落伤4例，砸伤1例。按照Levine-Edwards分型：Ⅱ型9例，Ⅱa型5例。所有患者入院均行颈椎正侧位X线片、CT平扫及三维重建、MRI检查。术前神经功能按美国脊髓损伤协会（ASIA）分级均为E级。记录术前及末次随访时的创伤后颈椎临床评分、视觉模拟评分（VAS）、枢椎移位及成角数据；观察椎间节段融合情况，有无椎间隙塌陷、融合器移位及畸形愈合。结果14例患者均手术顺利，手术时间平均为61min（45-116min）。术中无喉上神经、舌下神经、咽喉壁及血管损伤；术后无喉头水肿、吞咽困难、舌肌瘫痪、血肿形成及伤口感染等并发症。平均随访24．2个月（4～32个月），手术融合节段及骨折部位平均于术后3个月时骨性融合，末次随访时融合器无下沉、移位，椎间无塌陷，未见畸形愈合。创伤后颈椎临床评分：术前（53．1±7．2）分，末次随访时（91．1±5．0）分（P〈0．05）；颈部疼痛VAS：术前3．38（2．43，4．33）分，末次随访时0．58（0，1．29）分（P〈0．05）；枢椎移位：术前（4．0±1．5）mln，末次随访时（1．3±1．2）mm（P〈0．05）；枢椎成角：术前（9．2±4．7）°，末次随访时（2．14-1．9）°（P〈0．01）。结论应用ROI-C行颈前路融合手术治疗Ⅱ型及Ⅱa型Hangman骨折，可以获得良好的融合率，临床疗效满意。Objective To analyze the clinical effect of anterior cervical decompression with double-way connection intervertebral fusion device （ROI-C） implantation for type Ⅱ or type Ⅱ a Hangman fracture. Methods A retrospective study was made on 14 patients with type Ⅱ or type Ⅱ a Hangman fracture treated with anterior cervical ROI-C implantation between February 2011 and March 2014. The patients （ 11 males and 3 females ） were aged between 22 and 46 years （ mean, 26.4 years ）. Nine patients sustained traffic injury, 4 fall injury and 1 crash injury. Nine patients were classified as typeⅡ and 5 type Ⅱ a according to the Levine-Edwards classification. All were completed cervical anteroposterior and lateral X-ray, CT scan, three-dimensional CT reconstruction and MRI examination after admission. American Spinal Injury Association （ASIA） grade E was noted in all before operation. Clinical posttraumatic neck score, visual analogue scale （VAS） as well as angle deformity and displacement of the axis were recorded before operation and at the latest follow-up. Results All patients were operated successfully. Mean operation time was 61 min（range,45-116 min）. There were no injuries of superior laryngeal nerve, hypoglossal nerve, throat wall and vessel during operation. Laryngeal edema, dysphagia, paralysis of tongue, hematoma and wound infection were not observed after operation. Mean period of follow-up was 24.2 months （ range, 4-32 months）. All segments and fracture sites showed solid fusion after 3 months. No cages became subsided or displaced, no discs collapsed, and no malunion occurred at the latest follow-up. Data of preoperation and latest follow-up differed significantly with respect to clinical posttraumatic neck score [ （53.1± 7.2） points vs. （91.1 ± 5.0） points ], VAS [ 3.38 （2.43,4.33） points vs. 0.58 （0,1.29） points ], axis displacement [ （4.0 ± 1.5 ） mm vs. （ 1.3 ± 1.2） mm ], and angle deformity of the axis[（9.2±4.7）° vs. （2.1 ±1.9）°] （P�

关 键 词：颈椎 减压术 外科 骨折固定术 内 HANGMAN骨折 

分 类 号：R687.3[医药卫生—骨科学]