后路钉棒固定不植骨与植骨融合治疗不稳定Hangman骨折的疗效比较  

Comparison of efficacies of posterior screw-rod fixation and fusion with or without bone graft in the treatment of unstable Hangman′s fracture

作　　者：张建 王清 李广州 钟德君 王高举 陈润森 张浩 张鹏鑫 ZHANG Jian;WANG Qing;LI Guangzhou(Department of Orthopedics,the Affiliated Hospital of Southwest Medical University,Luzhou,646000,China)

机构地区：[1]西南医科大学附属医院骨科,泸州市646000

出　　处：《中国脊柱脊髓杂志》2024年第1期5-13,共9页Chinese Journal of Spine and Spinal Cord

基　　金：四川省医学会科研项目(S17075);泸州市人民政府-西南医科大学科技战略合作项目(No.2020LZXNYDJ40)。

摘　　要：目的:比较后路钉棒固定不植骨与后路钉棒固定植骨融合治疗不稳定Hangman骨折的疗效。方法:回顾性分析2014年1月~2020年12月在我院接受颈后路钉棒内固定手术且随访2年以上的39例不稳定Hangman骨折患者的临床及影像学资料,平均随访3.2±1.9年(2~9年)。男性31例,女性8例,年龄43.1±16.1岁(13~70岁)。其中22例接受单纯后路钉棒固定术(不植骨组:A组),17例接受后路钉棒固定自体髂骨植骨融合术(植骨组:B组)。记录并比较两组患者手术时间、术中出血量、术后并发症,术前、术后1周、术后3个月及末次随访时疼痛视觉模拟评分(VAS),术前、术后3个月及末次随访时颈椎功能障碍指数(NDI),术前及末次随访时美国脊髓损伤协会(ASIA)脊髓损伤分级,末次随访时Odom′s分级。在术前、术后1周及末次随访时颈椎侧位X线片上测量并比较两组间C2/3移位、成角和颈椎前凸角,颈椎正侧位X线片及三维CT上观察骨折愈合情况、C2/3后方关节突关节(小关节)、椎体间融合情况。结果:39例患者均顺利完成手术。手术时间A组99.3±14.2min,B组137.9±19.5min;术中出血量A组94.6±12.6mL,B组140.6±17.8mL,A组比B组手术时间更短,术中出血量更少(P<0.05)。A组2例术后发生浅表切口感染,B组1例术后发生浅表切口感染、4例供骨区疼痛,予以对症处理后均好转。两组患者术后1周、术后3个月及末次随访的VAS评分和术后3个月及末次随访的NDI较术前明显改善(P<0.05),两组间各随访时间点比较无统计学差异(P>0.05)。末次随访时两组患者ASIA分级及Odom′s分级无统计学差异(P>0.05)。两组患者术后1周及末次随访时C2/3成角、移位及颈椎前凸角较术前显著性改善(P<0.05),两组间各随访时间点上述指标比较无统计学差异(P>0.05)。末次随访时,39例患者骨折全部愈合良好。A组C2/3双侧小关节均自发融合,椎体前缘自发融合1例,椎体后缘自发融合9例,�Objectives:To compare the efficacies of posterior screw-rod fixation and fusion without bone graft and with bone graft in the treatment of unstable Hangman′s fracture.Methods:The clinical and imaging data of 39 patients with unstable Hangman′s fracture who underwent posterior cervical screw-rod internal fixation in our hospital between January 2014 and December 2020 and were followed up for more than 2 years were analyzed retrospectively,and the follow-up period was 3.2±1.9 years(range from 2 to 9 years).There were 31 males and 8 females with an average age of 43.1±16.1 years(13-70 years).Among the patients,22 cases received simple posterior screw-rod fixation(non-bone graft group:group A),and 17 cases received posterior screw-rod fixation and autogenous iliac bone graft fusion(bone graft group:group B).The operative time and intraoperative blood loss,postoperative complications,the visual analogue scale(VAS)preoperatively,at 1 week,3 months and final follow-up after surgery,and neck disability index(NDI)preoperatively,at 3 months and final follow-up after surgery,and American Spinal Cord Injury Association(ASIA)grade preoperatively and at final follow-up,and Odom′s grade at final follow-up were recorded and compared between the two groups.The displacement,angulation of C2/3 and cervical lordosis angle were measured on lateral X-ray films before operation,at 1 week after operation and final follow-up.The fracture healing,and C2/3 posterior facet joint and interbody fusion were observed on anteroposterior and lateral X-ray films and three-dimensional CT images.Results:All the 39 patients completed the operation successfully.The operative time was 99.3±14.2min in group A and 137.9±19.5min in group B,the intraoperative blood loss was 94.6±12.6mL in group A and 140.6±17.8mL in group B,and group A was shorter in operative time and less in blood loss(P<0.05).Superficial incision infection occurred in 2 cases in group A and 1 case in group B,and 4 cases of pain in bone donor area occurred in group B,all of w

关 键 词：HANGMAN骨折 后路钉棒固定 不植骨 自发融合 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]