前路C2,3复位融合治疗Hangman骨折

Anterior C2,3 reduction and fusion for the treatment of Hangman's fractures

目的 探讨前路C2,3复位融合方法治疗Hangman骨折的疗效及Hangman骨折的稳定性判定与治疗方法选择.方法 对近年收治的29例Hangman骨折患者进行回顾性研究,男2l例,女8例;年龄21～66岁,平均44.6岁.患者均表现为颈痛,颈部活动受限,5例单侧上肢、2例双侧上肢麻木及无力,四肢麻木无力1例.患者均行X线、三维CT和MR检查,并测量C2,3位移和成角;其中Levine-Edwards分型Ⅰ型3例,Ⅰ a型2例,Ⅱ型15例,Ⅱa型7例,Ⅲ型2例.入院后均常规行仰伸位颅骨牵引后行手术治疗,前路切除损伤的C2,3椎间盘,采用髂骨块或椎间融合器椎间融合,带锁钢板固定.术后戴费城颈托保护6周.结果 术后随访6～54个月,平均28.6个月.平均3.6个月时骨折处愈合,平均4.2个月时椎间植骨融合.颈痛、肢体麻木等症状消失,但颈部活动度较正常有所下降.术前C:移位2～16mm,平均(3.7±1.2)mm,术后平均移位(2.4+1.0)mm;术前C2,3成角1°-33°,平均7.4°±1.6°,术后平均2.3°±1.1°,两者均较术前明显下降(P＜0.05).无内固定失败及感染等并发症发生.结论 MR和CT检查在Hangman骨折的稳定性判定中具有重要的补充作用.前路C2,3复位融合方法是治疗Hangman骨折的优良术式.

Objective To determine the treatment efficacy of anterior C2,3 reduction and fusion for the management of Hangman's fractures and discuss the stability definition and therapeutic options.Methods A retrospective review of 29 cases,including 21 males and 8 females,with Hangman's fractures was performed.The ages of the patients were 21 to 66 years.average 44.6 years.All the patients complained neck pain and limitation of movement of the neck.Numbness and weakness appeared in unilateral upper limb in 5 cases.bilateral upper limbs in 2 cases and four limbs in 1 case.All patients received anteriorposterior and lateral X-rays.MR and three dimensional CT scans.Initial and final radiographs were measured for translation and angulation of C2,3According to the Levine-Edwards classification,there were 3 cases for type Ⅰ,2 for type Ⅰ a,15 for type Ⅱ,7 for type Ⅱ a and 2 for type Ⅲ.Skull tractions under extension poison were used in all patients after admission.Then an anterior C23 discectomy followed an interbody fusion.either with iliac bone or box cages,and locking plates fixation were performed.Philadelphia collars were used for protection for 6 weeks after surgeries.Results The follow-up was 6-54 months,average 28.6 months.The fracture fused at 3.6 months and bone graft fused at 4.2 months in average.Complains of neck pain and numbness of limbs disappeared after surgeries.But the range of neck motions decreased compared to the normal people.Translation of C2 was 2-16 mm preoperatively,average(3.7+1.2)mm,decreased to (2.4±1.0)mm postoperatively.Angulation of C2,3 was 1°-33°preoperatively,average 7.4°±1.6°,decreased to 2.3°±1.1°postoperatively,which both with statistical significance(P＜0.05).No internal fixation failures or infections were observed.Conclusion MR and CT scans act as important complementary roles in the estimarion of the stability of Hangman’s fractures.Anterior C2,3 interbody fusion and plate fixation is a suitable treatment option for patients with unstable Hangman’s fractures.