不稳定Hangman骨折的手术治疗

Pedicle screw fixation for treatment of the unstable Hangman fractures

目的探讨颈椎后路椎弓根螺钉内固定治疗不稳定Hangman骨折的临床效果。方法2001年10月至2006年4月收治15例不稳定Hangman骨折患者，骨折按照Levine—Edwards分型：Ⅱ型3例，ⅡA型4例，Ⅲ型8例。入院后均给予颅骨牵引，行颈后路切开复位、椎弓根螺钉内固定术治疗。在复位不完全时，脱位不严重者采用C2，3复位固定；脱位严重时，在C2椎弓根钉和C3侧块螺钉固定的基础上，增加C4的侧块螺钉固定。结果术后随访3～30个月，平均17个月。6例术前脊髓功能Frankel分级为D级的患者术后恢复至E级，所有患者术后复查X线片示：骨折全部获得骨性愈合，无明显的颈椎功能受限。结论C2，3或C2,4后路椎弓根螺钉内固定手术是治疗不稳定Hangman骨折的有效方法，可达到早期复位、坚强固定的目的。

Objective To investigate the clinical effects of pediele screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pediele screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 eases of Ⅱ type, 4 cases of UA type, 8 eases of Ⅲ type. Results The mean follow-up time was 17 （3 to 30） months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional C4 fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pediele screw fixation of C2, 3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.