钩-钉联合固定治疗不稳定型枢椎创伤性滑脱

Hook screw combination to treat for the unstable Hangman's fracture

目的:探讨钩-钉联合固定治疗不稳定型枢椎创伤性滑脱(Hangman骨折)的临床效果。方法:2005年3月至2008年5月采用钩-钉联合固定治疗不稳定Hangman骨折17例,男15例,女2例;年龄28～75岁,平均46岁。损伤原因:高处坠落伤8例,交通伤5例,摔伤3例,重物砸伤1例。骨折类型:Ⅰ型0例,Ⅱ型3例,Ⅱa型5例,Ⅲ型9例。神经功能按Frankel分级标准,C级3例,D级5例,E级9例。结果:17例均获得随访,随访时间3～22个月,平均8个月。术后所有病例均获得完全复位;无上颈椎疼痛及C2、C3复位丢失情况发生;术前神经功能正常者,术后无一例出现神经损伤症状;不全瘫患者神经功能均有不同程度的恢复,其中C级3例,术后1例恢复到D级,2例恢复到E级;D级5例,全部恢复到E级。结论:经颈后路钩-钉联合固定治疗不稳定型Hangman骨折,能获得有效的解剖复位,维持颈椎坚强的生物学稳定。

Objective：To explore the clinical effect of Hook screw combination treatment for the unstable Hangman＇s fracture. Methods：From March 2005 to May 2008,17 patients with unstable Hangman＇s fracture,of whom there were 15 males and 2 females aged from 28 to 75 years old with an average age of 46 years,were treated by Hook screw combination. Of injury reasons,there were 8 patients caused by falling injury,5 patients caused by traffic accident injury,3 patients by tumble and 1 patient by crash injury of heavy object. Type of bone fracture：there were 3 patients with type Ⅱ,5 patients with type Ⅱa and 9 patients with type Ⅲ. The level of nerve injury according to ASIA criteria,there were 3 patients with grade C,5 patients with grade D and 9 patienst with grade E. Results：All patients were followed up for 3 to 22 months averaged 8 months. All patients were recover completely without upper cervical spine pain and C2,C3 loss of reduction. No patients＇ nerve function was injured in the patients with normal function before operation. The patients with injured nerve function before operation improved 1 to 2 grade. Conclusion：The method of transarticular Hook screw combination treatment for the unstable Hangman＇s fracture can obtain effective anatomical reduction and biological stability.