摘要
目的探讨C2,3椎弓根固定术治疗不稳定性Hangman骨折的疗效。方法2001年10月至2005年10月,治疗不稳定性Hangman骨折患者26例,男18例,女8例;年龄21～56岁,平均38.5岁。根据Levine等分型标准:Ⅱ型11例,ⅡA型10例,Ⅲ型5例。脊髓功能Frankel分级,D级6例,E级20例。采用后侧入路,在“C”型臂X线机监视下复位骨折后,采用Axis或Vertex系统经C2,3椎弓根螺钉固定,行椎板间和关节突间植骨融合。以C2侧块中点为进针点,进针方向为向头端倾斜15°～25°,向中线倾斜20°～25°;螺钉长度为26～30mm,直径为3.5～4.0mm。以C3侧块的外上象限中点为进针点,水平面上进针方向为向头端内侧倾斜35°～45°,矢状面上丝锥在C3向头侧倾斜约10°,进深为20～25mm,长度为18～24mm,直径为3.5～4.0mm。结果术后骨折复位满意,且全部愈合,颈椎功能无明显受限,无一例发生脊髓及椎动脉损伤。6例术前有神经症状者术后1周均有不同程度恢复。随访6～54个月,平均29个月。6例术前脊髓功能Frankel分级为D级的患者术后恢复至E级。术后CT检查示:C2椎弓根螺钉偏外3枚(3/52);C3椎弓根螺钉偏外进入横突孔7枚(7/52);未发现螺钉偏内病例。按Mayo(McGrory)颈椎创伤后临床评价标准评分,优16例,良7例,可3例,优良率88.46%。结论经C2,3椎弓根固定治疗不稳定性Hangman骨折可获得满意疗效。
Objective To introduce the method of C2,3 pedicle screw fixation for management of unstable Hangman fractures and evaluate the clinical effects. Methods From October 2001 to October 2005, 26 cases with unstable Hangman fractures were treated using Axis and Vertex pedicle screw system. According to the classification system designed by Levine depending on the radiological manifestations of Hangman fractures, there were unstable fractures in 26 cases, who were subdivided into type Ⅱ in 11 cases, type Ⅱ A in 10 cases and type Ⅲ in 5 cases. There were 18 males and 8 females, aging from 21 to 56 years with an average of 38.5 years. According to Frankel scale, graded as spinal injury D in 6 cases and E in 20 cases. Points of entry for C2 screw insertion were located at the entrance at the posterior aspect of lateral mass. The drill bit was parallel to both of the medial and superior border of C2 pars interarticularis（usually 15°-25° cephalad to the transverse plane and 20°-25° medial to the sagittal plane）. The screw hole in the posterior cortex was overdrilled. 3.5-4.0 mm screws （26-30 mm, determined by depth gauge） were drived in after the cortex being tapped. The points of screw penetration for the C3 pedicles was slightly lateral to the center of the articular mass and close to the inferior margin of the inferior articular process of the cranially adjacent vertebra. The insertion angle of the pedicle screw was 35°-45° medial to the midline in the transverse plane. 3.5-4.0 mm screws, determined by depth gauge were drived in after the cortex being tapped. The whole procedure was done under monitoring of ＂C＂-arm fluoroscopy for safety and accuracy. Results All patients were followed up from 6 to 54 months, with the average of 29 months. There were no screw loosing and breakage, and no spinal cord and vertebral artery injury after surgery. 3 screws were placed too close to the vertebral artery canal in C2 and 7 screws in C3, but without clinical consequences. There were 16 cases in excellent, 7 good, 3 fair according to Mayo （McGrory） scores. Conclusion C2.3 pedicle screw fixation is a effected method for management of unstable Hangman fractures, which proved its value as a method achieving solid bony fusion combined with low rate of complications.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2006年第9期590-593,共4页
Chinese Journal of Orthopaedics
关键词
枢椎
骨折
脊椎前移
骨螺丝
脊柱融合术
Axis
Fractures
Spondylolisthesis
Bone screws
Spinal fusion
