摘要
目的比较单一前路颈椎间盘切除内固定椎间融合术与单一后路内固定融合术治疗不稳定性Hangman骨折术后矢状面重建的差异。方法回顾性分析2007年1月至2022年12月因不稳定性Hangman骨折于南京大学医学院附属鼓楼医院骨科-脊柱外科行手术治疗的43例患者资料。男32例,女11例;年龄(47.9±14.2)岁;根据治疗方法不同分为前路组(采用单一前路颈椎间盘切除内固定椎间融合术,23例)和后路组(单一后路内固定融合术,20例)。比较两组患者的手术时间、术中出血量、住院时间,比较两组患者入院、术后即刻、末次随访时的颈椎侧位X线片上测量C_(2)脱位、枕颈角、C_(2)~C_(3)角、颈椎前凸角(CL)和颈椎矢状面垂直距离(cSVA),比较两组患者入院、末次随访时的疼痛视觉模拟评分(VAS)和颈椎功能障碍指数(NDI)。采用美国脊髓损伤协会(ASIA)分级评估患者术前、末次随访时神经功能状态,并观察并发症的发生情况。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。前路组患者手术时间[(90.3±13.6)min]、住院时间[(13.1±2.4)d]均短于后路组[(153.9±26.1)min、(18.5±1.9)d],术中出血量[(57.2±15.9)mL]少于后路组患者[(123.2±22.5)mL],差异均有统计学意义(P<0.05)。两组患者术后即刻C_(2)脱位、C_(2)~C_(3)角较术前均明显矫正,末次随访时维持良好,差异均有统计学意义(P<0.05)。前路组患者术后即刻、末次随访时C_(2)~C_(3)角前凸重建均优于后路组患者。两组患者末次随访时疼痛VAS评分、NDI均较入院时显著降低,差异均有统计学意义(P<0.05),两组患者间比较差异均无统计学意义(P>0.05)。前路组4例和后路组2例患者术前ASIA分级为D级的患者末次随访时均改善至E级。前路组3例患者术后出现声音嘶哑,术后3个月随访时均恢复正常,末次随访时无声音嘶哑、吞咽困难等。两组患者末次随访时均融合良好,无内固定松动、断裂等并发症发生。结论单一前路颈椎间盘切除内固定椎间融合术与单一后路内固定融合术治疗不稳定性Hangman骨折均可获得满意疗效,前者在C_(2)~C_(3)角前凸重建方面更具优势。
ObjectiveTo compare the anterior cervical discectomy and fusion(ACDF)and posterior cervical fusion(PCF)in the sagittal plane reconstruction for unstable Hangman fractures.MethodsA retrospective study was conducted to analyze the clinical data of 43 patients who had been surgically treated at Division of Spine Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital for unstable Hangman fractures from January 2007 to December 2022.There were 32 males and 11 females aged(47.9±14.2)years.They were divided into 2 groups according to their surgical methods:an anterior group of 23 cases who were subjected to ACDF and a posterior group of 20 cases who were subjected to PCE.The 2 groups were compared in terms of operation time,intraoperative bleeding,hospitalization time,and the C_(2) subluxation,occipitocervical angle,C_(2)-C_(3) angle,cervical lordosis(CL),and cervical sagittal vertical axis(cSVA)measured on the lateral cervical spine X-rays over the time points of hospital admission,immediate postoperation,and the final follow-up,as well as in terms of the visual analog scale(VAS)for pain and neck disability index(NDI)over the time points of hospital admission and the final follow-up.The American Spinal Injury Association(ASIA)classification was used to assess the neurological status of the patients before surgery and at the final follow-up,and complications were documented.ResultsThe differences in preoperative general data between the 2 groups were not statistically significant,indicating comparability(P>0.05).The operation time[(90.3±13.6)min]and hospitalization time[(13.1±2.4)d]in the anterior group were significantly shorter than those in the posterior group[(153.9±26.1)min and(18.5±1.9)d],and the intraoperative bleeding volume in the anterior group[(57.2±15.9)mL]was significantly less than that in the posterior group[(123.2±22.5)mL](P<0.05).Compared with the preoperative period in both groups,the C_(2) subluxation and C_(2)-C_(3) angle were significantly corrected at immediate postoperation,and well maintained at the final follow-up.The C_(2)-C_(3) angle was significantly better corrected in the anterior group than in the posterior group at immediate postoperation and the final follow-up.The VAS scores and NDI at the final follow-up in both groups were significantly lower than those at admission(P<0.05),while the differences between the 2 groups were not statistically significant(P>0.05).Four cases in the anterior group and 2 cases in the posterior group all had their preoperative ASIA grade D improved to grade E at the final follow-up.Three patients in the anterior group developed postoperative hoarseness,which returned to normal at the 3-month follow-up.There was no hoarseness or dysphagia at the final follow-up.Both groups achieved fine fusion at the final follow-up,showing no complications like loosening or fracture of internal fixation.ConclusionIn the sagittal plane reconstruction for unstable Hangman fractures,both ACDF and PCF can lead to satisfactory clinical and radiological outcomes,but the former shows a significant advantage in reconstruction of C_(2)-C_(3) lordosis.
作者
方寅羽
王玉
李海波
蒋军
王斌
俞杨
邱勇
朱泽章
Fang Yinyu;Wang Yu;Li Haibo;Jiang Jun;Wang Bin;Yu Yang;Qiu Yong;Zhu Zezhang(Division of Spine Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China)
出处
《中华创伤骨科杂志》
北大核心
2025年第4期314-321,共8页
Chinese Journal of Orthopaedic Trauma
基金
江苏省医学创新中心项目(CXZX202214)。
关键词
枢椎
骨折
脱位
矢状面
前路
后路
Axis
Fractures,bone
Dislocation
Sagittal alignment
Anterior
Posterior
