第2、3颈椎前路融合联合第2颈椎椎弓根固定治疗不稳定Hangman骨折

Combined anterior C2,3 reduction and fusion with posterior compressive C2 pedicle screw fixation for the treatment of unstable Hanngman＇s fractures： 16 cases review

目的探讨前路C2,3复位融合联合C2椎弓根钉加压固定方法治疗不稳定Hangman骨折的疗效。方法Hangman骨折患者16例，男性12例，女性4例；年龄24—65岁，平均41岁。均行X线片、三维CT和MRI检查，并测量C2,3移位和成角。术前C2移位3—16mm，平均（4．2±1．4）mm；术前C2，3平均成角（8．6±2．1）°。入院后常规行仰伸位颅骨牵引后均行手术治疗，前路切除损伤的C2，3椎间盘，采用髂骨块或cage椎间融合，带锁钢板固定；C型臂透视示骨折间隙仍较大，一期后路行C2椎弓根钉加压固定。其中Levine-Edwards分型Ⅱ型12例，Ⅱa型2例，Ⅲ型2例。结果随访6-38个月，平均26个月。患者骨折处和椎间植骨平均4个月时全部融合，颈痛、肢体麻木等症状消失，但颈部活动度较正常有所下降。术后C2移位平均移位（2．3±1．1）mm；术后平均（2．6±1．0）°，较术前均明显下降。无内固定失败及感染等并发症。结论Hangman骨折原有分型不够准确，应结合MRI和CT判定不稳定性Hangman骨折。前路C2,3复位融合联合C2椎弓根钉加压固定方法是一种能取得良好复位和功能恢复的术式。

Objective To determine the outcome of combined anterior C2,3 reduction and fusion with posterior compressive C2 pedicle screw fixation for the management of unstable Hangman＇s fractures. Methods Sixteen cases of unstable Hangman＇s fractures were retrospectively reviewed through X-ray, MRI and three dimensional CT scans. Pie- and postoperative radiographs were measured for translation and angnlation of C2,3. Skull traction under extension poison was conducted in all the patients right after their admission. Then anterior C2,3 discectomy followed by interbody fusion, either with iliac autograft or with box cage, and locking plate fixation were performed in each case. Because unsatisfied reduction, mainly residual large fracture gap or kyphosis, was found by the C-arm fluoroscopy during operations, posterior compressive C2 pedicle screw fixation was performed in one stage. According to the Levine-Edwards classification, there were 12 cases of type Ⅱ,2 of type Ⅱ a and 2 of type Ⅲ in this group. Results Follow-up ranged 6 - 38 months, averaged 26 months. Facture union and bone graft fusion were completed in an average of 4 months after operation. Complaints of neck pain and numbness of limbs disappeared in all patients after surgery, but range of neck motion decreased compared with normal people. Translation of C2 decreased from （4. 2 ± 1.4） mm preoperatively to （2. 3 ± 1.1 ） mm postoperatively, while angulation of C2,3 decreased from 8.6° ±2. 1° preoperatively to 2. 6° ± 1.0° postoperatively. Both have statistical significance （ P 〈 0. 05 ）. No implant failure or infection was observed. Conclusions The classification of Hangman＇s fracture should be modified in combination with MRI and CT scans to determine the stability of the fracture. Combined anterior C2,3 reduction and fusion with posterior compressive C2 pedicle screw fixation is the treatment of choice for patients with unstable Hangman＇s fractures.