Hangman骨折的手术治疗

Surgical treatment of Hangman fracture

目的：探讨Hangman骨折的临床、影像学特点及治疗。方法：回顾分析14例Hangman骨折患者的临床资料，男13例，女1例；平均年龄31岁。根据Levine-Edwards的X线分型：Ⅰ型1例，Ⅱ型7例，ⅡA型3例，Ⅲ型3例。3例合并神经症状。3例采用后路Q椎弓根螺钉固定；8例前路手术，行C2．3椎间盘切除及植骨，颈前路钢板固定；3例后路复位，行前C2．3椎间盘切除植骨钢板内固定术。结果：14例全部获得5～63个月随访，术后3个月均获得骨性融合，颈椎序列良好，颈椎伸屈侧位片显示颈椎稳定，无内固定松动、脱出及断裂，无椎动脉损伤、神经损伤、脑脊液漏及切口感染等手术并发症。3例脊髓损伤神经功能恢复良好。结论：手术治疗Hangman骨折安全有效，Ⅱ型、ⅡA型、Ⅲ型应及早手术治疗，颈椎前路融合加钢板内固定术可使Hangman骨折获得良好的即时稳定性，有利于患者早期下床活动，不影响颈椎活动度，是Ⅱ型、ⅡA型、Ⅲ型Hangman骨折较好的手术方法。

Objective：To study the clinical and radiographic characteristics of Hangman fracture and to explore its diagnosis and treatment. Methods：Among 14 patients with Hangman fracture who were treated from August 1999 to June 2004,13 were male and 1 was female, with an average age of 31 years. According to the classification system designed by Levine and Edwards depending on the radiological manifestations of Hangman fracture, 1 patient was Type Ⅰ ,7 were Type Ⅱ ,3 were Type ⅡA and 3 Type Ⅲ. Three patients were accompanied with neurological injury symptoms. Within 14 patients, 3 were treated with posterior pedicle screw fixation at C2,8 were treated with anterior approach combined with intervertebral disc resection of C2,3 and bone grafting, plate internal fixation, other 3 patients were treated with posterior reduction combined with anterior resection of C2.3 intervertebral disc and bone grafting, plate internal fixation. Results： All the patients who were followed up from 5 to 63 months （mean 27 months） had solid fusion based on flexion and extension radiographs at 3th months after operation. 14 patients attained completely reduction and the normal lordosis were maintained. There were no such complications occurred as loosening, displacement or breakage of internal fixators, leak of cerebrospinal fluid and vertebral artery injury, nerve injury, leak of spinal fluid and infection of incisional wound. Three patients with incompletely neurological defect got improved postoperatively. Conclusion：Tbe surgical treatment of Hangman fracture is safe and trustworthy,especially for Type Ⅱ , ⅡA and Ⅲ fracture. The operation should be performed as early as possible. Anterior fusion combined with plate internal fixation for unstable Hangman fracture provides an immediate stability, which is benefit to early exercises and maintain the maximal motion range of cervical spine. The method is a better method to treat Hangman fracture of Type Ⅱ , ⅡA and Ⅲ.