枢椎椎弓根拉力螺钉内固定技术治疗Hangman骨折

目的：探讨枢椎椎弓根拉力螺钉内固定治疗Hangman骨折的适应证,并评价其临床应用价值。方法：2003年7月至2007年6月共收治Hangman骨折患者28例。Levine-Edwards分型：Ⅰ型6例,Ⅱ型17例,Ⅱa型5例。脊髓功能Frankel分级：D级3例,E级7例。取C2侧块中点为进针点,根据C2椎弓根的内缘和上缘走行确定进针方向,向头侧倾斜25°～30°,向中线倾斜30°～35°。应用测深器确定螺钉长度,一般为24～30mm。结果：术中未发生椎动脉损伤及其他并发症。术后所有患者随访4～48个月,平均20个月。神经功能恢复正常,所有骨折均在术后6个月愈合,颈椎活动范围接近正常,未出现颈椎不稳和螺钉松动。结论：单节段枢椎椎弓根拉力螺钉内固定技术可使Hangman骨折获得良好的即刻稳定性,且较少干扰上颈椎的生理功能。其适应证应限于骨折可复位的病例。

Pedicle lag screw for the treatment of indicated Hangman fractures

Objective： To define the indication of C2 pedicle lag screw to treat Hangman fractures and evaluate its results. Methods：Twenty-eight patients with Hangman fractures were enrolled from July 2003 to June 2007. Six, 17 and 5 patients classified as type Ⅰ ,Ⅱ and Ⅱ a injuries respectively according to Levine-Edwards classification and graded as D spinal injury in 3 cases and E in 7 cases according to Frankel scale. The entry points of screws were located at middle point of lateral mass. The direction of screw is determined based on the direction of the medial and superior border of C2 pedicle ,usually 25° to 30° cephalad to the transverse plane and 30° to 35° medial to the sagittal plane. The length of screws range from 24 to 30 ram. Results：There were no vertebra artery injuries or other complications during the operation. A mean follow-up time was 20 months （4 to 48 months）. All cases gained bony union at the 6th postoperative month with complete neurological function recovery. The range of neck rotation was restored normal without cervicle spinal instability and lag screws loosing found. Conclusion： Single segmental pedicle lag screw internal fixation provides instantly stability to Hangman fracture and scarcely affects the physiological functions of upper eerviele spine. With appropriate indications of the techniques should be reducible Hangman fracture.