枢椎椎弓根拉力螺钉微创治疗Hangman骨折的临床研究

The clinical study of minimally invasive percutaneous new special C2 transpedicular lag-screw fixation for treatment of Hangman＇s fracture Liu

目的 探讨枢椎椎弓根拉力螺钉微创治疗Hangman骨折的临床疗效。方法 2015年10月至2017年6月对25例Hangman骨折患者采用红外导航辅助下枢椎椎弓根拉力螺钉微创内固定手术治疗,男18例,女7例;年龄28~70岁,平均（46.1±13.3）岁。根据Levine-Edwards分型标准：Ⅰ型16例、Ⅱ型6例、ⅡA型3例。车祸伤20例,坠落伤5例。单纯Hangman骨折19例,Hangman骨折合并Ⅱ型齿突骨折2例、Ⅰ型寰椎骨折2例,合并脾破裂1例,合并肋骨骨折、血气胸1例。根据美国脊柱损伤协会（American spinal injury association,ASIA）脊髓损伤分级,D级3例、E级22例。采用疼痛视觉模拟评分（visual analogue scale,VAS）对患者术前、术后颈部疼痛进行评估,记录患者手术时间、颈椎活动度及骨性愈合情况。对于手术前后颈痛VAS评分采用重复测量方差分析进行统计分析。结果 25例患者均获得随访,随访时间3~24个月,平均（12.5±6.0）个月。手术时间平均为（65.9±12.1） min。所有患者术后均得到满意复位,骨折断端分离≤ 2 mm,无明显成角。术后第1天、1个月、3个月及末次随访时颈痛VAS评分均较术前明显降低,差异均有统计学意义（t第1天=24.7、t1个月=25.8、t3个月=23.1、t末次随访=24.1,P〈 0.001）。3例患者由术前ASIA分级D级恢复至E级。术中均未发生脊髓或椎动脉损伤,无术后感染、内固定失败、颈椎畸形、骨折再移位及不愈合等并发症。末次随访时均获得骨性愈合且无颈椎活动度丢失,骨愈合时间平均为（3.4±0.8）个月。结论 红外导航辅助下枢椎椎弓根拉力螺钉微创治疗Hangman骨折取得了满意的临床疗效,具有微创精准、安全可靠、即刻稳定等优点,可以作为治疗Hangman骨折的一种新选择。

Objective To evaluate the clinical effects of minimally invasive percutaneous new C2 transpedicular lag-screw fixation for management of Hangman＇s fractures. Methods From October 2015 to June 2017, 25 patients who had Hangman＇s fracture were operated with minimally invasive percutaneous new C2 transpedicular lag-screw fixation assisted by infrared navigation, among them there were 18 male and 7 female, aged from 28 to 70 years [average （46.1±13.3） years]. According to the Levine-Edwards classification： 16 patients were TypeⅠ, 6 patients were TypeⅡ and 3 patients were TypeⅡA. The cause of the injury was road traffic accident in 20 patients and fall from height in 5 patients. 19 patients were simple Hangman＇s fracture and other associated lesions included odontoid fracture of TypeⅡ（2 patients）, atlas fracture of TypeⅠ （2 patients）, rupture of spleen （1 patient）, and rib fractures （1 patient）. According to American Association for spinal cord injury, graded as spinal cord injury D in 3 cases and E in 22 cases. The clinical outcomes were evaluated by visual analog scale （VAS） scores and related indicators, such as operation time, the range of motion（ROM） of cervical spine and ratio of bony union were recorded. The pre- and post- operative VAS scores of neck pain were compared with repeated measures analysis of variance. Results The mean follow-up time was （12.5±6.0） months, ranging from 3 to 24 months. Satisfactory reduction was obtained in all cases （minimal translation ≤ 2 mm without obvious C2,3 angulation）. The average operation time was （65.9±12.1） min. At first day, one month, three months and the last follow-up, VAS scores of neck pain decreased comparing with preoperational measurements. There was significant difference between the pre-and post- operative VAS scores of neck pain （t=24.7, 25.8, 23.1, 24.1,P〈0.001）. According to American Association for spinal cord injury, three cases restored from D to E. There was no spinal cord or vertebral artery injury during operation and there was no screw loosing or breakage and cervical malformation happened during follow-up period. Bony fusion was achieved in all of these cases and the range of neck rotation was stored normal at the last follow-up. The average time of Bony fusion was （3.4±0.8） months. Conclusion The primary clinical efficacies of minimally invasive percutaneous new C2 transpedicular lag-screw fixation for treatment of Hangman＇s fracture were satisfactory, which carries precision and safety, immediate stability and more reliable. So it could be considered as a new choice for management of Hangman＇s fractures.