Hangman骨折的分类及治疗

Sorting Hangman's fracture for surgical treatment

目的:探讨Hangman骨折的手术治疗策略。方法:回顾性分析长征医院手术治疗的54例Hangman骨折的临床资料,根据Levine分型标准,I型3例,Ia型4例,Ⅱ型28例,Ⅱa型8例,Ⅲ型11例。男38例,女16例;年龄22～62岁。致伤原因:交通伤28例,高处跌落伤16例,重物砸伤10例。2例出现神经症状。Ⅱ型和Ⅱa型有9例伴有C2、3椎间盘突出采用前路C2、3椎间盘摘除、植骨及钢板固定;有明显不稳的7例加用后路椎弓根固定;不伴有C2、3椎间盘突出的20例则采用后路固定。Ⅲ型骨折有4例术前复位满意并不伴有椎间盘突出,直接后路固定;另7例均先前路C2、3椎间隙减压植骨钢板固定,其中复位不满意的3例加做C1后弓切除减压,枕颈融合。结果:除3例Ⅲ型外,骨折脱位均得到纠正,所有患者均获得骨性融合,颈部疼痛症状全部消失。结论:Levine分型对临床治疗有较好的指导作用。Ⅱ型骨折有C2、3椎间盘突出而选择前路固定,否则行后路固定。Ⅲ型骨折术前复位完全则可按Ⅱ型骨折同样处理,复位不完全则需先行前路C2、3融合固定,再行后路固定。

To study the treatment strategy and clinical results of surgical treatment for Hangman＇s fracture. Methods： Data of 54 cases of Hangman＇s fracture admitted and recorded in Changzheng Hospital（Shanghai,China） were gathered for this retrospective study. By the classification system designed by Levine in accordance with radioiogical manifestations of Hangman＇s fracture, among the total 54 cases, there were type I in 7 cases,and unstable fracture in 47 cases,who were subdivided into type Ⅱ in 28 cases,type Ⅱ a in 8 cases and type Ⅲ in 11 cases. 38 of them were males and 16, females,aging from 22 to 62 years. 28 cases resulted from traffic accident, 16 from falling down, 10 from being smashed by heaey object and another 2 cases were complicated with neurological symptoms. Of all type Ⅱ and Ⅱ a,there were 9 cases with C2.3 inter-vertebral disc hemia received anterior fusion and internal fixation with anterior plate; 7 heavy unstable cases again received posterior intemal fixation via vertebral pedicle, other 20 cases without inter-vertebral disc hemia received posterior internal fixation. 4 cases of type Ⅲ obtained satisfied preoperative reduction with no intervertebral disc hemia. Another 7 cases of type Ⅲ received anterior fusion and intemal fixation,and 3 cases with dissatisfied postoperative reduce received C1 posterior arch resection depression and pillow-cervicum fusion. Results ： Apart from 3 cases of type Ⅲ ,the rest had gained satisfied reduction and fusion, and the complain of neck arch had disappeared. Conclusion ： The classification system designed by Levine can be important role in clinic for surgical treatment of Hangman＇s fracture. Anterior fusion and internal fixation with anterior plate is preferable for type Ⅱ fractures with C2.3 intervertebral disc hernia. On the contrary, patients without inter-vertebral disc hernia tends to be selected posterior intemal fixation. Type Ⅲ fractures can be dealt with the same treatment with type Ⅱ , but,if it is dissatisfied, posterior internal fixation may be performed.