摘要
目的探讨不稳定性Hangman骨折的手术治疗策略。方法回顾性分析28例不稳定性Hangman骨折患者的临床资料,根据Levine和Edwards的X线分型标准,Ⅱ型骨折9例,ⅡA型骨折12例,Ⅲ型骨折7例。男22例,女6例;年龄17～62岁,平均39岁。受伤至手术时间1～16d,平均4d。致伤原因:交通事故伤13例,头部重物砸伤6例,坠落伤、头面部撞击地面5例,颈椎过伸伤2例,其他原因2例。12例合并神经症状。20例采用了前路融合加钢板内固定术,8例行后路融合固定术,评价两组的手术效果。结果所有患者术后均获得骨性愈合,一旦复位固定,神经功能恢复良好。20例前路内固定和4例后路椎弓根螺钉固定者,术后颈椎活动度无明显改变;4例后路复位、植骨加钢丝固定者,术后颈椎旋转活动度减少50%～70%。结论颈椎前路融合加钢板内固定术治疗不稳定性Hangman骨折可获得良好的即时稳定性,有利于患者早期下床活动,且不影响颈椎活动度。
Objective To study the treatment strategy and clinical results of surgical management for unstable Hangmans fracture. Methods From May 1994 to December 2001, 52 cases of Hangmans fracture were admitted and recorded in Changhai hospital and Changzheng hospital. According to the classification system designed by Levine and Edwards depending on the radiological manifestations of Hangmans fracture, there were stable fracture (type Ⅰ) in 24 cases, all of whom were treated conservatively, and unstable fracture in 28 cases, who were subdivided into type Ⅱ in 9 cases, type ⅡA in 12 cases and type Ⅲ in 7 cases. The clinical results of 28 cases of unstable Hangmans fracture were analyzed in the study retrospectively. Of 28 unstable fractures, there were 22 males and 6 females, aging from 17 to 62 years with an average of 39 years, and all patients were treated surgically. The interval from injury to the index operation was from one to sixteen days(mean, 4 days). The mechanisms of injury were traffic accident in 13 cases, bruise in 6 cases, falling down in 5 cases, hyperextension in 2 cases and other cause in 2 cases. 12 cases were complicated with neurological symptoms. The patients were given traction from 2 kg to 4 kg increasing gradually; and bedside X-ray examination was taken to confirm the reduction of fracture two to seven days later. 20 cases received anterior fusion and internal fixation with anterior plate; other 8 cases received posterior fusion and internal fixation. The treatment results of anterior and posterior approach group were evaluated. Results One week after operation, X-ray films showed complete reduction of C2,3 dislocation and satisfied internal fixation in all patients. 20 cases of anterior fixation and 4 cases of posterior pedicle screws fixation obtained normal fuction of cervical spine, however, 4 cases using posterior approach, bone grafting and wire fixation had cervical rotational loss of 50% to 70%. Temporary larynx edema occurred in 7 cases, and cured with spray inhalation and dehydration therapy within 72 hours. All of the cases achieved bony fusion; and the neurological function were restored satisfactorily once the fracture and dislocation were reduced. Conclusion Anterior fusion and plate fixation for unstable Hangmans fracture provide an immediate instability, early ambulation and retain the maximal motion range of cervical spine.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第10期599-601,共3页
Chinese Journal of Orthopaedics
