颈前路钢板内固定治疗Ⅱ型和ⅡA型Hangman骨折的疗效分析  

Clinical efficacy of anterior cervical plate fixation for type Ⅱ and type ⅡA Hangman′s fracture

作　　者：范永飞 郭国栋 刘刚 FAN Yong-fei;GUO Guo-dong;LIU Gang(Department of Orthopaedic Surgery, Jingling Hospital, Nanjing University School of Medicine /General Hospital of Eastern Theater Command,PLA,Nanjing 210002, Jiangsu, China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)骨科,南京医学硕士研究生210002

出　　处：《医学研究生学报》2019年第2期163-166,共4页Journal of Medical Postgraduates

基　　金：南京军区面上项目(14MS102)

摘　　要：目的临床上对于Ⅱ型和ⅡA型Hangman骨折的手术入路选择仍有争议。文中旨在评价颈前路钢板内固定治疗Ⅱ型和ⅡA型Hangman骨折的临床疗效。方法回顾性分析2014年1月至2017年8月东部战区总医院骨科收治的17例Ⅱ型和ⅡA型Hangman骨折患者。所有患者均采用颈前路钢板内固定术治疗,统计分析手术时间,术中出血量,术后引流量等,术前、术后3个月、术后1年采用视觉模拟评分(VAS)评估颈肩部疼痛,颈椎功能障碍指数量表(NDI)评估颈椎功能,以及评估放射学指标(C2/3局部后凸角、C2椎体前移距离)及植骨融合情况。结果手术时间平均为95.6(80～116)min,术中出血量平均为32.6(25～50)mL,术后引流量平均为35.6(25～50)mL,平均住院时间为6.2(5～8)d。所有患者均未出现脑脊液漏、神经症状加重、切口感染、内固定失败等并发症。术后3个月C2/3局部后凸角[(-2.12±3.20)°]、C2椎体前移距离[(1.02±0.63)mm]与术前[(12.24±2.17)°、(3.47±1.46)mm]比较差异有统计学意义(P<0.05);VAS、NDI与术前比较差异亦有统计学意义(P<0.05)。术后1年VAS、NDI[(1.23±0.44)、(4.82±2.81)分]较术后3个月[(1.65±0.49)、(13.47±2.70)分]降低(P<0.05)。结论对于Ⅱ型和ⅡA型Hangman骨折患者,采用颈前路钢板内固定术可有效恢复颈椎生理曲度,重建颈椎稳定性,且具有创伤小、并发症少、恢复快等优势。Objective There are still disputes about the clinical treatment of typeⅡand typeⅡA Hangman′s fracture.The article aimed to explore the clinical efficacy of anterior cervical plate fixation for typeⅡand typeⅡA Hangman′s fracture.Methods Seventeen patients with typeⅡand typeⅡA Hangman′s fracture combined with intervertebral disc injury were analyzed in our department from January 2013 to August 2017,including 12 males and 5 females,aged from 27 to 76 years old,with an average age of 54.9 years.The operative time and intraoperative blood loss and postoperative drainage were recorded.The effectiveness was evaluated using visual analogue scale(VAS)for occipitocervical pain,and the Neck Disability Index(NDI)score for cervical vertebra function.Radiological indices(C2/3 local kyphotic angle,C2 translation)and bone graft fusion were evaluated by Xray.Results All the patients were followed up successfully.No cerebrospinal fluid leakage occurred during the operation.There were no broken nails,broken slab,and loose internal fixation.All the patients were almost free from occipitocervical pain and neurological function of all patients improved partially.The VAS and NDI scores were significantly improved at 3 months after operation and one year when compared with preoperative scores(P<0.05).The C2/3 local kyphotic angle was corrected significantly with the mean preoperative 12.24±2.17 degrees,initial postoperative-2.12±3.20 degrees and the latest follow-up-1.88±2.67 degrees respectively(P<0.05).The C2 translation was also corrected significantly with the mean preoperative 3.47±1.46 mm,initial postoperative 1.02±0.63 mm,and the latest follow-up 1.21±0.56 mm respectively(P<0.05).All the patients had good bone graft fusion.Conclusion For typeⅡand typeⅡA Hangman′s fracture,the method of anterior cervical plate fixation can effectively restore cervical curvature and reconstruct cervical stability,which is featured by the advantage of less trauma,fewer complications and faster recovery.

关 键 词：颈前路 内固定 HANGMAN骨折 植骨 

分 类 号：R683[医药卫生—骨科学]