ACDF联合钢板内固定术治疗不稳定Hangman骨折的临床研究  

Clinical study of ACDF combined with plate internal fixation in treatment of unstable Hangman fracture

作　　者：田野 杨新明[1] 阴彦林[1] 张培楠[1] 贾永利[1] TIAN Ye;YANG Xin-ming;YIN Yan-lin;ZHANG Pei-nan;JIA Yong-li(Department of Orthopedics,the First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院骨一科,河北张家口075000

出　　处：《颈腰痛杂志》2023年第5期748-750,共3页The Journal of Cervicodynia and Lumbodynia

基　　金：河北省技术创新引导计划项目(编号:20477707D)。

摘　　要：目的探讨颈前路椎间植骨融合术(anterior cervical discectomy fusion,ACDF)联合钢板内固定术治疗不稳定Hangman骨折的临床疗效。方法本研究观察对象为2017年2月~2020年2月该院32例不稳定Hangman骨折患者,男18例、女14例,年龄(44.91±4.92)岁;骨折Levine-Edwards分型:Ⅱ型18例,ⅡA型10例,Ⅲ型4例,均采用ACDF联合钢板内固定术治疗。结果手术均顺利完成,手术时间(71.06±8.18)min,出血量(73.04±9.12)mL,住院时间(5.12±1.34)d,随访(18.81±4.01)个月。术后3~6个月所有患者植骨均融合、骨折均愈合;术中1例脑脊液漏,术后1例患者出现吞咽不适,2例发音异常;术后3个月、末次随访VAS评分指数较术前显著降低(P<0.05);合并脊髓损伤者术后3个月、末次随访ASIA分级较术前均显著提升。结论ACDF联合钢板内固定术治疗不稳定Hangman骨折创伤小,恢复快,并发症发生率低,具有较高的骨折愈合率以及植骨融合率,能显著减轻疼痛症状。Objective To explore the clinical effect of anterior cervical discectomy fusion(ACDF)combined with plate internal fixation in the treatment of unstable Hangman fracture.Methods Thirty-two patients with unstable Hangman fracture in our hospital from February 2017 to February 2020 were selected as the study subjects,including 18 males and 14 females,aged(44.91±4.92)years old.Levine-Edwards classification was as follows:18 cases of typeⅡ,10 cases of typeⅡA,and 4 cases of typeⅢ,and they were all treated with ACDF combined with plate internal fixation.Results The operations were successfully completed.The operation time was(71.06±8.18)min,the blood loss was(73.04±9.12)mL,the hospital stay was(5.12±1.34)d,and the follow-up was(18.81±4.01)months.All the bone grafts were fused and the fractures healed3 to 6 months after operation;1 case of cerebrospinal fluid leaked during the operation,1 case had swallowing discomfort after operation,and 2 cases had abnormal pronunciation.The VAS score at 3 months after operation and the last follow-up was significantly lower than that before operation,and there was no significant difference between the last and 3 months after operation(P<0.05).In patients with spinal cord injury,the ASIA grades at 3 months after operation and at the last follow-up were improved compared with those before operation.Conclusion ACDF combined with plate internal fixation for the treatment of unstable Hangman fracture has the advantages of small trauma,quick recovery,low complication rate,high fracture healing rate and bone graft fusion rate,which can significantly reduce pain symptoms.

关 键 词：颈前路椎间植骨融合术 钢板内固定 不稳定Hangman骨折 

分 类 号：R683.2[医药卫生—骨科学]