颈后路短节段固定治疗Ⅱ型及ⅡA型Hangman骨折

The treatment of type Ⅱand ⅡA Hangman's fracture with posterior cervical oligo-segmental fixation

目的:探讨C2椎弓根螺钉固定以及C2椎弓根螺钉+C3侧块螺钉钢板内固定治疗Ⅱ型及ⅡA型Hangman骨折的适应证以及手术疗效。方法:自2001年1月至2003年6月对7例Ⅱ型及ⅡA型Hangman骨折的患者施以颈后路短节段内固定治疗,其中对4例ⅡA型Hangman骨折的患者施以颈后路直接C2椎弓根螺钉固定,对3例Ⅱ型Hangman骨折的患者施以C2椎弓根螺钉+C3侧块螺钉钢板内固定。结果:所有患者内固定牢固,均获得骨性愈合,未出现与内固定相关的并发症,临床效果满意。结论:对于不稳定的Ⅱ型及ⅡA型Hangman骨折采取颈后路短节段内固定手术,可以获得良好的复位,固定牢固,可以早期下地活动,免除长期外固定的痛苦,是治疗Hangman骨折较为理想的方法。

Objective To observe the operative effects of C2 transpedicle screw fixation or C2 transpedicle screw fixation combined with C3 lateral mass screw plate fixation on Hangmans fracture, and to define its indications. Methods From January, 2001 to June, 2002, seven patients with type Ⅱor ⅡA Hangmans fracture were surgically treated with posterior cervical oligo segmental fixation, of which 4 cases with type ⅡHangmans fracture were treated with direct C2 transpedicle screw fixation and three cases with type ⅡA Hangmans fracture were treated with C2 transpedicle screw fixation combined with C3 lateral mass screw plate fixation. Results All the internal fixations were strong enough and have obtained bone fusion. No complications relative to internal fixation occurred and the clinical results were satisfactory. Conclusion The unstable type Ⅱand ⅡA Hangmans fracture can get a good reduction and be immobilized firmly by posterior cervical oligo segmental fixation. The patients can get off of bed to exercise during earlier period and the pain by reason of long term external fixation can be eliminated. It is suggested that both operations are ideal methods to treat the type Ⅱor ⅡA hangmans fracture.