摘要
目的评价颈前路钢板内固定治疗不稳定Hangman骨折的临床疗效。方法2006年5月-2010年5月,采用颈前路钢板内固定治疗不稳定Hangman骨折42例。其中男30例,女12例;年龄22~64岁,平均36.5岁。按Levine-Edwards分型标准,Ⅱ型25例,ⅡA型15例,Ⅲ型2例。8例合并脊髓损伤。受伤至手术时间3~14d,平均5d。手术前后行影像学检查,观察并评价颈椎生理曲度及C2.3,椎间高度,植骨融合及骨折愈合情况;采用疼痛视觉模拟评分(VAS)和颈椎功能障碍指数量表(NDI)评定患者颈部疼痛和功能恢复情况;对8例有脊髓损伤患者采用日本骨科协会(JOA)评分评定患者神经功能恢复情况。结果术后患者切口均Ⅰ期愈合,无神经症状加重、内固定失败等并发症发生。42例均获随访,随访时间2~5年,平均3.5年。术后3例患者出现饮水呛咳,4例出现吞咽困难,均于1周后自行缓解。患者颈枕部疼痛及颈部活动受限均明显缓解,8例脊髓损伤患者神经功能均有不同程度改善,6例有脊髓压迫者均解除压迫。x线片示植骨融合良好,融合时间6~8个月,平均6.5个月;骨折愈合时间9~12个月,平均10.5个月。术后3个月及末次随访时VAS、NDI评分及脊髓损伤患者JOA评分均较术前显著改善(P〈0.05),末次随访时较术后3个月进一步改善(P〈0.05)。末次随访时C2移位、成角均纠正,颈椎生理曲度重建,椎间高度恢复正常,旋转功能良好。结论颈前路钢板内固定可有效维持理想复位,具有融合率高、并发症少、对颈椎活动度影响小等优点,是手术治疗不稳定Hangman骨折的理想选择。
Objective To explore the effectiveness of anterior cervical plate internal fixation in the treatment of unstable Hangman fracture. Methods Between May 2006 and May 2010, 42 patients with unstable Hangman fracture were treated by anterior cervical plate internal fixation. There were 30 males and 12 females with an average age of 36.5 years (range, 22-64 years). According to the Levine-Edwards classification, 25 cases were rated as type Ⅱ, 15 cases as type II A, and 2 cases as type Ⅲ. Eight patients had spinal cord injury. The average interval between injury and operation was 5 days (range, 3-14 days). The X-ray, CT, and MRI were done preand post-operatively to evaluate the cervical physiological curvature, the intervertebral disc height of C2. 3, the fracture-healing, and bone fusion. The effectiveness was evaluated using visual analogue scale (VAS) for occipitocervical pain, Neck Disability Index (NDI) for cervical spine function, and the Japanese Orthopaedic Association (IOA) score for neurological functional recovery. Results All incisions healed by first intention. No neurological deterioration or internal fixation failure was observed. All of the patients were followed up 2-5 years (mean, 3.5 years). The complications were dysdipsia in 3 cases and dysphagia in 4 cases, which alleviated spontaneously after 1 week. All the patients were almost free from occipitocervical pain and the limited cervical spine motion. Neurological function was improved in 8 cases of spinal cord injury, and complete decompression was observed in 6 cases who had spinal cord compression. The bone fusion was observed at 6.5 months on average (range, 6-8 months); the mean fracture-healing time was 10.5 months (range, 9-12 months). The VAS, NDI, and IOA scores were significantly improved at 3 months after operation and last follow-up when compared with preoperative scores (P 〈 0.05), significant improvement scores were achieved at last follow-up when compared with the scores at 3 months (P 〈 0.05). The intervertebral disc height of C2, 3, the reconstructed curvature and stability of the cervical spine, and the spine movement were good. Conclusion The method of anterior cervical plate internal fixation can achieve satisfactory reduction and fusion, less complications, negligible impact on the cervical movement. So it is an ideal method to treat unstable Hangman fracture.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第6期728-732,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
HANGMAN骨折
创伤性枢椎滑脱
颈前路
钢板内固定
Hangman fracture Traumatic spondylolisthesis of the axis Anterior cervical approach Plateinternal fixation