后路C2~3钉棒内固定术治疗不稳定型Hangman骨折

Clinical effect of posterior C_(2～3) screw-rod fixation for treatment of unstable Hangman's fracture

目的探讨后路C_(2～3)钉棒内固定术治疗不稳定型Hangman骨折的临床疗效。方法对15例不稳定型Hangman骨折患者采用后路C_(2～3)钉棒内固定术治疗。采用X线及CT检查评估手术前后固定融合节段的完整性和稳定性,并评估患者的颈椎功能障碍指数(NDI)和颈部疼痛VAS评分的改善情况。结果手术时间80~131 min。患者均获得随访,时间6~32个月。术后无一例出现神经功能恶化,且未观察到内固定失败、感染及其他术中或术后并发症。患者的NDI在随访期间逐渐降低,术后第1天为83.9%±2.5%,末次随访时降低至22.4%±2.7%,术后1、3、6个月及末次随访与术后第1天比较差异均有统计学意义(P<0.05)。患者颈部疼痛VAS评分在随访期间逐渐降低,术后第1天为8.3分±1.2分,末次随访时降低至2.1分±0.8分,术后1、3、6个月及末次随访与术后第1天比较差异均有统计学意义(P<0.05)。结论后路C_(2～3)钉棒内固定术是治疗不稳定型Hangman骨折的有效方法。

Objective To investigate the clinical effect of posterior C2-3screw-rod fixation for unstable Hangman＇s fracture. Methods Fifteen patients with unstable Hangman＇s fracture underwent posterior C2-3 screw-rod fixation. X-ray and CT examination were used to evaluate the integrity and stability of the fixed fusion segments. Clinical effects were evaluated by using neck disability index （NDI） and visual analogue scale （VAS） during preoperative and postoperative follow-up period. Results The operative time was 80 - 131 min and follow-up period was 6 - 32 months. None of the patients had neurological deterioration after surgery, and no internal fixation failure, infection, or other intra0perative or postoperative complications were observed. NDI was gradually reduced during follow-up, NDI was 83.9% ±2. 5% at the postoperative 1 day, and was 22.4% ±2.7% at final follow-up,there were signifi- cant differences between the 1 st, 3rd＇, 6th month and the last follow-up and the postoperative 1 day（P 〈 O. 05 ）. VAS was gradually reduced during follow-up, The VAS for neck pain was 8.3 ± 1.2 at the postoperative 1 day, and while the final follow-up VAS was 2. 1 ±0. 8, there were significant differences between the 1 st, 3rd, 6th month and the last follow-up and the postoperative 1 day（P 〈 O. 05 ）. Conclusions Posterior C2-3 screw-rod fixation is effective in the treatment of the patients with unstable Hangman＇s fracture.