累及枢椎椎体的Hangman骨折七例报告

Report of Seven Cases of Hangman Fractures Involving Axis Body

目的探讨特殊Hangman骨折的损伤病理、诊断及治疗方法。方法收治累及枢椎椎体的Hangman骨折7例,患者均有C2、3不稳定,2例同时累及C1、2,损伤脊髓神经。均行C2、3前路融合术,加前路经寰枢关节螺钉内固定2例,减压2例。结果随访1～5.5年,骨折及C2、3或C1～3椎间均骨性愈合。除C1、2固定者头颈部旋转部分受限外,其他颈椎活动正常,神经功能恢复明显。结论累及枢椎椎体的Hangman骨折具有自身伤情特点,CT及三维重建可明确诊断。如未波及C1、2,其治疗同典型骨折,否则需酌情加寰枢关节融合术或齿状突骨折螺钉内固定术,前路手术值得推荐。

Objective To explore the traumatic pathologic feature, diagnosis and treatment of atypical Hangman fractures.Methods Of seven patients with special Hangman fractures occurring through the axis body unilaterally treated in our hospital, the midline part of the body was involved in one case, the lateral part closing to the middle portion in one, the posterior margin in five. Injuries of cervical spinal cord happened in two cases. Anterior C2.3 interbody fusion was taken in all cases, meanwhile, with anterior atlantoaxial transarticular screw fixation in two, and with decompression in two.Results These asymmetrical C2 injuries, great potential for neurological compromise, were always accompanied by C2.3 instability, while atlantoaxial instability happened in two cases. After follow-up of 1 -5.5 years, healing was noted in all fractures and C2.3 or C1-3 intervertebral spaces, and the function of the cervical spine activity and spinal cord recovered very well, except partly limited rotation of head and cervix after atlantoaxial fixation.Conclusion There is some specially injured pathology for the atypical Hangman＇s fractures, often diagnosed by CT and CT with three-dimensional reconstruction. The treatment of the special C2 fractures, if without concomitant lesions at C1-2 joint, is the same as that of the typical injuries, otherwise atlantoaxial fusion or screw fixation for odontoid fracture should be taken according to the traumatic condition. Anterior approach is worth being recommended for the atypical Hangman fractures.