椎弓根螺钉内固定治疗枢椎椎弓根骨折合并脊髓损伤

Pedicle screw fixation in treatment of acute Hangmans fracture and spinal cord injury

目的评价椎弓根螺钉内固定治疗枢椎椎弓根骨折(Hangman骨折)的临床应用价值。方法回顾性分析我科自1999年来收治的急性枢椎椎弓根骨折15例患者,其中Ⅰ型4例,Ⅱ型11例,均合并不同程度神经系统症状,行颅骨牵引复位后用AO纯钛皮质骨螺钉经峡部固定枢椎椎弓根骨折。结果经12～60个月随访,术后神经功能恢复按Frankel分级,有6例D级和5例C级恢复至E级,2例C级恢复至D级,1例B级恢复至C级,1例B级恢复至D级,半年后复查X线骨折均愈合,复位良好,无椎动脉损伤及其它术中、术后并发症。结论椎弓根螺钉内固定治疗早期枢椎椎弓根骨折,复位固定满意,有利于脊髓功能的恢复,且较少影响上颈椎功能。

Objective To evaluate the clinical outcomes of pedicle screw fixation in the treatment of Hangmans fracture. Methods The 15 patients who had been treated for acute Hangmans fracture in our department after 1999 were retrospectively analyzed. 4 of them were type I, and 11 type II. All the patients presented symptoms of nerve system at different degrees. They were treated with AO pure titanium cortex screw through isthmus after skull traction replacement. Results All the patients were followed up for 12 to 60 months. According to Frankle classification, 6 cases of Grade D and 5 cases of Grade C recovered up to Grade E, 2 cases of Grade C recovered to Grade D, 1 case of Grade B recovered to Grade C and 1 case of Grade B recovered to Grade D. X ray showed all the fractures healed up without vertebra artery injury or other complications. Conclusion The outcomes of pedicle screw fixation and reduction in treatment of acute Hangmans fracture are satisfactory, for the clinic technique promotes functional recovery of spinal cord, decreases the rate of infection and scarcely affects the function of upper cervical spine.