不稳定Hangman骨折颈椎前后路融合金属植入物内固定方式的对比

Comparison of anterior and posterior operation treatment for Hangman's fracture

背景:对于Hangman骨折,采用颈前路融合钢板置入内固定和后路C2椎弓根、C3侧块钉棒置入内固定,目前存在争议。目的:比较颈前路融合钢板置入内固定和后路C2椎弓根、C3侧块钉棒置入内固定治疗Hangman骨折的临床效果。方法:将26例Hangman骨折患者按随机数字表法分为2组,分别行颈前路减压植骨钛合金钢板置入内固定与后路C2椎弓根、C3侧块钉棒置入内固定治疗。结果与结论:与后路C2椎弓根、C3侧块钉棒置入内固定治疗比较,颈前路减压植骨钛合金钢板置入内固定治疗手术时间更短,术中出血与术后引流量更少(P<0.05)。两组术中、术后并发症差异无显著性意义。提示与颈椎后路手术内固定相比,颈椎前路融合植入物内固定手术治疗Hangman骨折手术时间短,术中出血量少,术后颈椎功能恢复良好。

BACKGROUND：Posterior C2-3 pedicle screws fixation have been used in internal fixation of Hangman＇s fracture.C2-3 anterior fusion and plate fixation has been used recently.OBJECTIVE：To evaluate the clinical effects of anterior versus posterior C2-3 pedicle screws on Hangman＇s fracture.METHODS：Twenty-six patients with Hangman＇s fracture were randomized into two groups,treated with anterior decompression bone fusion plus titanium plate implantation or posterior C2 pedicle screw plus C3 lateral mass screw-rod implantation.RESULTS AND CONCLUSION：The operation time,intraoperative bleeding and postoperative drainage were shorter or less in anterior cervical operation as compared with in posterior cervical operation（P 0.05）.There were no differences in intraoperative and postoperative complications between the two groups.The results demonstrated that C2-3 anterior fusion and plate fixation is a better method to treat Hangman＇s fracture,maintaining excellent reduction and achieving stability,compared with C2-3 posterior pedicle screws fixation.