颈前路椎间植骨融合内固定治疗Ⅱ型、Ⅱa型Hangman骨折

Anterior Fusion with Internal Fixation for the Treatment of Type Ⅱand Ⅱa Hangman's Fracture

目的探讨颈前路C2/3椎间盘摘除植骨融合锁定钢板内固定治疗Ⅱ型、Ⅱa型Hangman骨折的临床疗效。方法回顾2004-02/2012-09月间行颈前路C2/3椎间盘摘除植骨融合锁定钢板内固定术治疗的Hangman骨折36例,其中Ⅱ型29例、Ⅱa型7例,男21例,女15例,随访时间24~30个月(平均27个月),通过观察骨折愈合、椎间融合、疼痛改善、颈椎活动度、临床症状和功能,采用疼痛视觉模拟评分(visual analogue scale,VAS)和颈椎功能障碍指数量表(Neck Disability Index,NDI)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分标准评价患者疼痛和功能改善状况。结果 36例病例均获得随访,术后颈椎序列正常,功能良好,骨折愈合和骨性融合时间3至4个月,术后3个月及末次随访VAS、NDI及JOA评分显著改善(P<0.05,且末次随访时较术后3个月进一步改善。结论颈前路C2/3椎间盘摘除植骨融合锁定钢板内固定术是治疗Ⅱ型、Ⅱa型Hangman骨折的可靠选择。

Objective To explore the efficacy of anterior C2-C3 discectomy and fusion for the management of type Ⅱand Iia Hangman's fracture treated with internal fixation.Methods A total of 36 patients with 21 males and 15 females with type Ⅱ(29 cases) and Iia(7 cases) Hangman's fracture underwent anterior C2-C3 discectomy and fusion with internal fixation between February 2004 and September 2012.The follow-up ranged from 24 to 30 months,with an average of 27 months.The contents of the follow-up were X-ray and CT films,time of fracture-healing,bone fusion,the range of movement,symptoms and function of cervical spine.The efficacy was evaluated using visual analogue scale(VAS),Neck Disability Index(NDI) for cervical spine function,and the Japanese Orthopaedic Association(JOA) score for neurological functional recovery.Results At the final follow-up,36 patients were asymptomatic and regained a good functional outcome with no limitation of motion range.The anterior approach offers well-organized cervical spine column,high primary stability,a high bony fusion rate,a perfect synostosis of fracture.The VAS,NDI and JOA scores were significantly improved at 3 months after operation and last follow-up when compared with preoperative scores(P < 0.05).Conclusion Anterior C2-C3 discectomy and fusion with internal fixation is an advisable choice for the patient with type Ⅱ or Iia Hangman's fracture.