自锁式融合器及钛板内固定修复Hangman骨折的颈椎稳定性及融合率

ROI-C^(TM) cervical fusion or titanium plate for treatment of Hangman fractures: a comparison of cervical stability and fusion rate

背景:自锁式R OI-C TM融合器置入治疗各类颈椎病时,其零切迹设计可明显减少对食管及咽部的影响,并简化了手术操作步骤,但其是否能够同样满意地应用于H angman骨折,目前还没有文献报道。目的:比较自锁式R OI-C TM融合器和钛板内固定修复H angman骨折的颈椎稳定性、融合率及临床效果。方法:纳入21例Hangman骨折患者,其中男13例,女8例,年龄25-62岁,按照使用的内固定分为钛板组和R OI-C TM融合器组,其中15例选择钛板进行内固定,另6例选择自锁式ROI-C TM融合器进行内固定。修复前、修复后3d、修复后3个月,进行颈椎正侧位、过屈过伸位及颈椎CT检查,评估颈椎角度与水平位移及植骨融合率;同时评估目测类比评分与B azaz吞咽困难分级。结果与结论:R OI-C TM融合器组修复后3d的目测类比评分及Bazaz吞咽困难分级均优于钛板组(P<0.05),两组修复后3个月的目测类比评分及Bazaz吞咽困难分级比较差异无显著性意义。两组修复后3 d、3个月的椎体角度位移与水平位移均低于修复前(P<0.05),两组间不同时间点的椎体角度位移与水平位移比较差异均无显著性意义;修复后3个月,ROI-C TM融合器组枢椎滑脱完全复位率均高于钛板组(P<0.05),两组间植骨融合率比较差异无显著性意义。两组均未发生融合器或内固定物排异反应、内固定断裂及松动等不良反应。表明自锁式R OI-C TM融合器修复H angman骨折具有枢椎滑脱复位率高及术后早期吞咽困难少、颈部疼痛轻的优点。

BACKGROUND： The self-locking ROI-C TM interbody fusion has zero profile design which can significantly reduce the impact on the esophagus and pharynx, and also simplify the operation procedure. However, there is no report whether it has satisfactory outcomes in the treatment of Hangman fractures. OBJECTIVE： To compare the clinical effects of ROI-C TM or titanium plate internal fixation on postoperative cervical stability and fusion rate in the treatment of Hangman fractures. METHODS： Twenty-one cases of Hangman fractures were included, including 13 males and 8 females, aged 25-62 years old. Fifteen cases were treated with titanium plate internal fixation, and the other five cases were treated with ROI-C TM fusion device. Cervical anteroposterior and lateral radiographs, lateral flexion extension radiographs and CT scanning were carried out before, 3 days and 3 months after repair to assess angular displacement, horizontal displacement and fusion rate; visual analog scale score and Bazaz dysphagia score were determined. RESULTS AND CONCLUSION： At 3 days after operation, the ROI-C TM group was significantly better than the titanium plate group in visual analog scale scores and Bazaz dysphagia grade（P〈0.05）, and there were nosignificant differences in angular displacement and horizontal displacement（P〈0.05）. However, at 3 months after operation, there was no significant difference between the two groups in visual analog scale score, Bazaz dysphagia grade, angular displacement and horizontal displacement and fusion rate（P〈0.05）. Postoperative complete reduction rate of spondylolisthesis was higher in the ROI-C TM group than the titanium plate group（P〈0.05）. In each group, the angular displacement and horizontal displacement were significantly reduced at 3 day and 3 months after operation（P〈0.05）, but there was no significant difference at 3 days and 3 months after operation（P〈0.05）. No rejection reaction, internal fixation fracture and loosening occurred in the two groups. These findings indicate that the self-locking ROI-C TM fusion for treatment of Hangman fractures are characterized as higher reduction rate of spondylolisthesis, less dysphagia, and less neck pain.