不典型Hangman骨折影像学分型与治疗选择  

Imageology classification and treatment option for atypical Hangman fractures

作　　者：王清 党耕町[2] 李广州 钟德君 王松 王高举 Wang Qing;Dang Gengting;Li Guangzhou;Zhong Dejun;Wang Song;Wang Gaoju(Department of Spinal Surgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,Chin;Department of Orthopaedics,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]西南医科大学附属医院脊柱外科, 泸州646000 [2]北京大学第三医院骨科,100191

出　　处：《中华骨科杂志》2018年第19期1177-1185,共9页Chinese Journal of Orthopaedics

摘　　要：目的 探讨不典型Hangman骨折（atypical Hangman fracture,AHF）的分型及治疗。方法 按自定义标准,根据骨折形态,将AHF分为,A1型：一侧椎体后壁＋对侧关节突间部（下称椎弓根）骨折;A2型：一侧椎体后壁＋对侧关节突或（和）椎板骨折;B1型：双侧椎体后壁骨折,骨折线平行于椎体后壁;B2型：双侧椎体后壁骨折,一侧骨折线平行于椎体后壁,另一侧骨折线垂直于椎体后壁。将Levine-Edwards分类中的Ⅱ、Ⅱa和Ⅲ型骨折（无论是否合并脊髓损伤）以及合并脊髓损伤的Ⅰ型骨折（MRI显示C2-3之间信号异常）归为不稳定性骨折,其余为稳定性骨折。对稳定性骨折釆用保守治疗,不稳定骨折采用手术治疗。结果 2006年1月至2016年5月,AHF患者51例, 合并神经功能损伤12例。颈托固定4-6周的稳定性骨折13例（A1型12例,B1型1例）,手术治疗的不稳定性骨折38例（A1型18例,A2型14例,B1型4例,B2型2例）。釆用后路C2拉力螺钉＋C3螺钉固定A1型11例,A2型10例,B1型2例,B2型1例;单纯后路C2拉力螺钉固定A1型3例;后路C1-3椎弓根固定A1型1例,B1型1例; 前路C2-3融合钢板固定A1型3例,A2型4例;前路C2-3钢板＋后路C2拉力螺钉固定B1型1例,B2型1例。本组在C2椎弓根置入拉力螺钉31例58枚：A1组15例成功置入中螺纹14枚,短螺纹14枚,因钉道破坏松动置钉失败1例（2枚,中、短螺纹各1枚）;A2组10例置入长螺纹10枚、短螺纹10枚;B组6例置入拉力螺钉10枚,B1型4例成功置入短螺纹螺钉6枚,因钉道松动出血置入失败1例（2枚）;B2型2例成功置入短螺纹螺钉4枚。随访12-86个月,平均26个月,合并神经功能损伤12例患者脊髓功能明显改善。13例保守治疗患者获得C2椎弓骨性愈合。除外前后联合固定2例,后路手术29例,前路手术7例,无论是C2椎弓骨折的延长型畸形愈合,还是C2-3成角移位畸形,后路固定均明显优于前路C2-3钢板固定。前后路联合的2例和后路C1-Objective The purpose of the retrospective study was to introduce a treatment option for atypical Hangman fractures （AHF） based on a new classification. Methods Sixty-seven patients with Hangman fractures were treated with a comprehensive treatment strategy. Firstly, Hangman fractures were classified as typical or atypical （AHF） lesions using computed tomography scans of the cervical spine. Secondly, AHF was divided into 1 of 4 types （type A1, A2, B1, and B2） devised by us to clarify the feature of injury. Thirdly, the injury status of disco-ligamentous complex （intact/indeterminate/ruptured） was evaluated using magnetic resonance imaging.If it was a stable lesion, conservative treatment was recommended.If not surgical treatment using anterior or/and posterior stabilization and fusion at C2-C3 level was used. Results Fifty-one patients were identified with AHF. According to our classification, thirty patients were classified as type A1, 14 cases as typeA2, 5 cases as type B1, and 2 cases as type B2 lesions. Thirteen AHF without C2-C3 instability （12 as type A1 and 1 as type B1） were treated with non-operative treatment, and 38 AHF with C2-C3 instability （18 as type A1, 14 as type A2, 4 as type B1, and 2 as type B2） were treated with operative treatment. Three patients （all with type A1 lesions） with slightly displacement of C2-3 underwent isolated direct screw osteosynthesis. The remaining 35 underwent posterior stabilization and fusion at C2-C3 level： 24 patients with posterior approach with C2 lag screws and C3 non-lag screws fixation and fusion （11 as type A1, 10 as type A2, 2 as type B1, and 1 as type B2）; 3 patients with posterior approach with C1 and C3 screw-rod fixation and fusion （1 as type A1 and 1 as type B1）; 7 with anterior approach by C2-3 discectomy and fusion （3 as type A1 and 4 as type A2）; and 2 with anterior and posterior approach （1 as type B1 and 1 as type B2）. The average follow-up period was 26 months （range, 12-86 months）. Neck pain improve

关 键 词：脊柱骨折 分类法 骨螺丝 

分 类 号：R683[医药卫生—骨科学]