Hangman骨折伴椎间盘损伤的诊断与外科治疗

目的探讨Hangman骨折伴C2-3椎间盘损伤的病理特点及其外科治疗方法。方法21例Hangman骨折伴颈2-3椎间盘损伤患者,均进行颈椎前路C2-3椎间隙融合术,其中18例行颈前路钢板固定。分析其损伤类型、影像学特点和疗效。结果未出现神经症状加重、植骨块移位、吸收和切13感染等并发症,新鲜骨折的枢椎脱位和C2-3成角得到良好恢复,术后6个月C2-3植骨以及枢椎椎弓骨折都获得骨性融合。随访8个月至4年,平均随访2年7个月,绝大部分术前症状消失。结论Hangman骨折并不限定于枢椎椎弓根骨折,合并椎间盘损伤的Hangman骨折是一种特殊的骨折类型,颈椎前路融合手术是符合其病理生理特点的手术方法。

Diagnosis and surgical management of Hangman's fracture combined with intervertebral disc injury

OBJECTIVE: To study the pathology characteristics and management of Hangman's fracture combined with intervertebral disc injury. METHODS: Twenty-one patients suffered from this special injury were converged in this study. All patients underwent anterior C(2 - 3) discectomy and fusion, 18 cases were fixed by anterior cervical plate. The type of fractures, radiology characteristics, and clinical outcomes were investigated. RESULTS: No graft displacement or absorption, infection and neurologic deterioration occurred. All fresh dislocation of axis and C(2 - 3) angulation were corrected. Fusion of C(2 - 3) intervertebral space and pedicle fracture were acquired in all of the patients. After a mean follow-up of 31 months, ranging from 8 to 48 months, nearly all of the complains disappeared after operation. CONCLUSIONS: Hangman's fracture is not restricted at pedicle of the axis. Fracture combined with intervertebral disc injury is a special type of Hangman's fracture. Anterior discectomy and fusion of C(2 - 3) intervertebral disc is an effective operation method in accord with the pathophysiology of this special injury.