颈前路植骨融合内固定治疗HangmanⅡ、ⅡA型骨折  

Clinical Effect of Bone Grafting Fusion and Internal-fixation by the Anterior-Cervical Approach for Hangman Fracture of Type Ⅱ and ⅡA

作　　者：李嘉坤[1] 陈涛[1] 贾世青 刘昌生[1] 黄开[1] 

机构地区：[1]玉林市中西医结合骨科医院脊柱科,广西玉林537000

出　　处：《实用骨科杂志》2017年第9期769-771,780,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨颈前路植骨融合固定治疗HangmanⅡ、ⅡA型骨折的手术策略和临床疗效。方法回顾性分析我院2010年3月至2016年3月手术治疗的Hangman骨折16例,按Levine-Edwards分型,Ⅱ型12例,ⅡA型4例,男11例,女5例;年龄23~56岁,平均38.3岁。12例Ⅱ型患者术前予颅骨牵引复位,4例ⅡA型仅予颈托固定保护。16例患者均行颈前路C2~3椎间盘切除取自体髂骨或椎间融合器植骨钛板内固定术,其中2例加后纵韧带切除减压术。结果所有患者均获得随访,随访9~24个月,平均16个月。术后16例患者均未出现血管神经及食管损伤等并发症。术后颈部疼痛明显缓解,术前视觉模拟评分(visual analogue scale,VAS)平均6.1分,术后3dVAS评分平均2.3分。术后患者X线片检查枢椎均达到解剖复位,内固定位置良好,无松脱、断裂现象,C_(2~3)间隙植骨均获得骨性融合。结论颈前路C2~3间隙植骨融合内固定治疗HangmanⅡ、ⅡA型骨折,复位好,固定牢固,植骨融合率高,是一种安全、可靠、有效的方法。Objective To explore the operation strategy and the clinical effect of the treatment of bone grafting and fusion together with internal fixation by the Anterior-Cervical approach for Hangman typeⅡ andⅡA fractures.Methods 16 cases of patients with Hangman fracture in our hospital from March 2010 to June 2016 were analyzed retrospectively.There were 12 cases of typeⅡ and 4 cases of typeⅡA according to the rule of Levine-Edwards.11 patients were male and 5 patients were female,aged from 23 to 56 years old with an average of 38.3 years old.The 12 patients with typeⅡ fracture received the preoperative Skull-Traction-Reduction.The other 4 patients were only immobilized with the cervical gear.All the 16 patients underwen excision of C_（2~3） intervertebral disk by the anterior cervical approach and autogeneic ilium implantation or interbody fusion cage with Titanium plate internal fixation.2 of them received the decompressive resection of posterior longitudinal ligament.Results None of the 16 patients suffered from any complications like injuries in vessels,nerves or esophagus.The cervical pain was markedly alleviated.The preoperative VAS scoring was 6.1 points compared to the postoperative counterpart of 2.3 points.All the patients gained anatomic reattachment in the axis,which is confirmed by the X-ray examination.The locations of the internal fixation were good.There were no any loosening or rupture.The postoperative follow-up in 6 to 18 months revealed that all the cases had a bony fusion after the bone grafting at the cervical C_（2~3） level.Conclusion The treatment of bone grafting and fusion together with internal fixation by the Anterior-Cervical approach is a good choice for Hangman type Ⅱ and ⅡA fractures because of the good reduction,firm fixation and the high rate of bony fusion of the bone grafting.Therefore,it is a safe,reliable and effective treatment.

关 键 词：HANGMAN骨折 颈前路 内固定术 

分 类 号：R683.2[医药卫生—骨科学]