前路C2,3复位融合治疗Hangman骨折

目的 探讨前路C2,3复位融合方法治疗Hangman骨折的疗效及Hangman骨折的稳定性判定与治疗方法选择.方法 对近年收治的29例Hangman骨折患者进行回顾性研究,男2l例,女8例;年龄21～66岁,平均44.6岁.患者均表现为颈痛,颈部活动受限,5例单侧上肢、2例双侧上肢麻木及无力,四肢麻木无力1例.患者均行X线、三维CT和MR检查,并测量C2,3位移和成角;其中Levine-Edwards分型Ⅰ型3例,Ⅰ a型2例,Ⅱ型15例,Ⅱa型7例,Ⅲ型2例.入院后均常规行仰伸位颅骨牵引后行手术治疗,前路切除损伤的C2,3椎间盘,采用髂骨块或椎间融合器椎间融合,带锁钢板固定.术后戴费城颈托保护6周.结果 术后随访6～54个月,平均28.6个月.平均3.6个月时骨折处愈合,平均4.2个月时椎间植骨融合.颈痛、肢体麻木等症状消失,但颈部活动度较正常有所下降.术前C:移位2～16mm,平均(3.7±1.2)mm,术后平均移位(2.4+1.0)mm;术前C2,3成角1°-33°,平均7.4°±1.6°,术后平均2.3°±1.1°,两者均较术前明显下降(P＜0.05).无内固定失败及感染等并发症发生.结论 MR和CT检查在Hangman骨折的稳定性判定中具有重要的补充作用.前路C2,3复位融合方法是治疗Hangman骨折的优良术式.     

前路减压植骨融合及钛板固定治疗Hangman骨折

目的 探讨颈前路减压植骨融合及钛板固定治疗Hangman骨折的临床疗效.方法 2004年6月至2008年12月共收治20例Hangman骨折患者,男14例,女6例;年龄35～62岁,平均49.2岁.根据Levine-Edwards分型标准:Ⅱ型10例,ⅡA型7例,Ⅲ型3例.所有患者术前均经颅骨牵引,14例行颈前路C_(2-3)椎间盘切除、植骨融合钢板固定术,6例行C_3椎体次全切除、植骨融合钢板固定术.治疗前后根据国际脊髓损伤评分(ASIA)标准对患者进行感觉和运动评分,并对手术前后影像学资料进行比较分析.结果 20例患者术后获7～51个月(平均25.6个月)随访,患者神经功能恢复良好.ASIA感觉评分术前、术后1个月及末次随访时平均分别为(145.2±25.6)、(166.2±31.5)、(212.2±33.2)分,三者比较差异均有统计学意义(P<0.05).ASIA运动评分术前、术后1个月及末次随访时平均分别为(53.3±15.2)、(68.5±18.7)、(87.3±21.3)分,三者比较差异均有统计学意义(P<0.05).术后X线片示6个月内植骨均获骨性融合,稳定性良好,无钢板及螺钉松动、断裂等并发症发生.结论 颈前路减压植骨融合及钛板固定治疗不稳定Hangman骨折具有减压彻底、有效恢复生理前凸、植骨融合率高、能早期活动等优点,是一种较好的治疗方法.

Abstract：

Objective To study clinical outcomes of anterior fusion with internal fixation for trau-matic spondylolisthesis of the axis (Hangman's fracture). Methods From June 2004 to December 2008, 20 patients with traumatic spondylolisthesis of the axis were treated operatively. They were 14 males and 6 females, aged from 35 to 62 years, with an average of 49.2 years. According to the classification system designed by Levine and Edwards, the radiological manifestations revealed type Ⅱ in 10 cases, type ⅡA in 7 cases and type Ⅲ in 3 cases. All cases achieved anatomic reduction by skull traction before operation. Fourteen cases underwent anterior C2-3 discectomy followed by insertion of a bone spacer for fusion and an-terior plating. Six cases underwent anterior C3 subtotal vertebrectomy, strut graft insertion, and anterior plating. The sensation and motion of the patients were evaluated pre- and postoperatively according to ASIA scoring system. Results of X-ray, CT and MRI examinations were also measured and compared pre-and post-operatively. Results The average follow-up time was 25.6 (7 to 51) months. All bone grafts ac-quired stable fusion in 6 months, the neurological functions were restored satisfactorily, and no plates or screws broke or loosened. Conclusion Anterior fusion and the internal fixation is a good alternative method for treatment of instable Hangman's fracture, because it has advantages of complete decompression, a high rate of successful bony fusion and early ambulation.     

Magerl技术联合Apofix夹治疗Ⅱ型齿状突骨折

目的介绍后路内固定治疗Ⅱ型齿状突骨折的方法。方法28例Ⅱ型齿状突骨折合并寰枢椎不稳患者采用经后路Apofix及C1,2经关节螺钉治疗。结果共放置经关节螺钉55枚,其中1例因椎动脉损伤仅进行了单侧放置。术后并发感染2例,经清创治疗后愈合,无内固定失败和脊髓损伤等并发症。随访6～34个月,植骨全部融合。结论Magerl技术联合Apofix技术是治疗Ⅱ型齿状突骨折的有效方法,可提供有效的固定和提高植骨融合率。     

经皮前路螺钉治疗Ⅱ型齿状突骨折——附12例报告

齿状突骨折是一种常见的颈椎损伤,Anderson-D’AlonzoⅡ型骨折即齿状突与枢椎椎体连接处的骨折,其晚期骨不愈合的发生率高,因此目前所争论的问题也都集中于对其治疗的方法上。国内近几年开展了齿状突螺钉内固定术,虽然保留了寰、枢椎的功能,提高了骨折愈合率,但系切开手术,创伤     

Hangman骨折的手术治疗

目的:探讨Hangman骨折的临床、影像学特点及治疗。方法:回顾分析14例Hangman骨折患者的临床资料,男13例,女1例;平均年龄31岁。根据Levine-Edwards的X线分型:Ⅰ型1例,Ⅱ型7例,ⅡA型3例,Ⅲ型3例。3例合并神经症状。3例采用后路C2椎弓根螺钉固定;8例前路手术,行C2,3椎间盘切除及植骨,颈前路钢板固定;3例后路复位,行前路C2,3椎间盘切除植骨钢板内固定术。结果:14例全部获得5~63个月随访,术后3个月均获得骨性融合,颈椎序列良好,颈椎伸屈侧位片显示颈椎稳定,无内固定松动、脱出及断裂,无椎动脉损伤、神经损伤、脑脊液漏及切口感染等手术并发症。3例脊髓损伤神经功能恢复良好。结论:手术治疗Hangman骨折安全有效,Ⅱ型、ⅡA型、Ⅲ型应及早手术治疗,颈椎前路融合加钢板内固定术可使Hangman骨折获得良好的即时稳定性,有利于患者早期下床活动,不影响颈椎活动度,是Ⅱ型、ⅡA型、Ⅲ型Hangman骨折较好的手术方法。     

应用Solis融合器置入治疗Ⅱ型及Ⅱa型Hangman骨折的临床疗效

目的:评价Solis椎间融合器置入治疗Ⅱ型及Ⅱa型Hangman骨折的临床疗效。方法:2006年1月～2011年11月,我科采用经前路Solis椎间融合器置入治疗Ⅱ型及Ⅱa型Hangman骨折患者17例,术中应用颈椎牵开器牵开椎间,通过紧张韧带进一步复位骨折。其中男11例、女6例,年龄19～41岁,平均26.2岁,按Levine-Edwards分类法Ⅱ型11例,Ⅱa型6例。于术后1周、3个月、6个月及末次随访时复查X线片,记录术前及末次随访时的枢椎移位及成角数据,记录术前及末次随访时的创伤后颈椎临床评分、颈部疼痛的VAS评分观察临床疗效。术前与末次随访时各数据间行t检验。结果:手术时间平均为78min(55～135min);术中出血量平均为22.5ml(10～50ml)。术中无喉上神经、咽喉壁及血管损伤,术后无喉头水肿、血肿形成及伤口感染等手术并发症。平均随访25.1个月(6～48个月),手术节段及骨折部位平均于3个月时骨性融合,未见畸形愈合,末次随访时融合器无下沉、无移位、椎间无塌陷。创伤后颈椎临床评分:术前平均为48分(45～63分),末次随访时为92分(83～97分);颈部疼痛VAS评分术前平均为6.9分(6～9分),末次随访时为1.1分(0～2分);枢椎成角术前平均为-8.6°(-20～6°),末次随访时为+3.5°(0～+8°);枢椎移位术前平均为3.4mm(1～5.5mm),末次随访时为1.2mm(0～2.0mm)。以上两组数据间差异均有统计学意义(P<0.05)。结论:应用Solis椎间融合器置入治疗Hangman骨折可行,手术操作简单、耗时短、创伤小、融合率高且有利于颈椎稳定。     

C1,2椎弓根钉棒固定治疗寰椎骨折（Jefferson骨折）疗效分析

目的探讨寰枢椎椎弓根钉内固定融合技术治疗寰椎骨折（Jefferson骨折）的临床疗效和应用价值。方法对2005年5月-2008年1月收治的17例寰椎骨折病例进行回顾性分析,患者均予后路寰枢椎椎弓根钉棒固定术并行自体髂骨植骨融合。结果术中未发生与置钉相关的并发症。所有病例术后均获随访,随访时间为12-24个月。患者的临床症状均得到不同程度的改善。复查X线片、CT,未发现患者上颈椎失稳或复位丢失,螺钉位置良好,无松动、断钉,寰枢椎均获骨性融合。术后随访效果满意。结论寰枢椎椎弓根钉棒固定治疗寰椎骨折（Jefferson骨折）,能使上颈椎获得即刻稳定,效果良好,是寰枢椎后路固定术中较好的手术方式之一。     

C1，2椎弓根钉棒固定治疗寰椎骨折（Jefferson骨折）疗效分析

【摘要】 目的 探讨寰枢椎椎弓根钉内固定融合技术治疗寰椎骨折（Jefferson骨折）的临床疗效和应用价值。 方法 对2005年5月~2008年1月收治的17例寰椎骨折病例进行回顾性分析,患者均予后路寰枢椎椎弓根钉棒固定术并行自体髂骨植骨融合。 结果 术中未发生与置钉相关的并发症。所有病例术后均获随访,随访时间为12~24个月。患者的临床症状均得到不同程度的改善。复查X线片、CT,未发现患者上颈椎失稳或复位丢失,螺钉位置良好,无松动、断钉,寰枢椎均获骨性融合。术后随访效果满意。 结论 寰枢椎椎弓根钉棒固定治疗寰椎骨折（Jefferson骨折）,能使上颈椎获得即刻稳定,效果良好,是寰枢椎后路固定术中较好的手术方式之一。     

第2、3颈椎前路融合联合第2颈椎椎弓根固定治疗不稳定Hangman骨折

目的 探讨前路C2,3复位融合联合C2椎弓根钉加压固定方法治疗不稳定Hangman骨折的疗效.方法 Hangman骨折患者16例,男性12例,女性4例;年龄24～65岁,平均41岁.均行X线片、三维CT和MRI检查,并测量C2,3移位和成角.术前C2移位3～16 mm,平均(4.2±1.4)mm;术前C2,3 平均成角(8.6±2.1)°.入院后常规行仰伸位颅骨牵引后均行手术治疗,前路切除损伤的C2,3 椎间盘,采用髂骨块或cage椎间融合,带锁钢板固定;C型臂透视示骨折间隙仍较大,一期后路行C,椎弓根钉加压固定.其中Levine-Edwards分型Ⅱ型12例,Ⅱa型2例,Ⅲ型2例.结果 随访6～38个月,平均26个月.患者骨折处和椎间植骨平均4个月时全部融合,颈痛、肢体麻木等症状消失,但颈部活动度较正常有所下降.术后C2移位平均移位(2.3±1.1)mm;术后平均(2.6±1.0)°,较术前均明显下降.无内固定失败及感染等并发症.结论 Hangman骨折原有分型不够准确,应结合MRI和CT判定不稳定性Hangman骨折.前路C2,3复位融合联合C2椎弓根钉加压固定方法是一种能取得良好复位和功能恢复的术式.     

3D打印、逆向工程技术结合体外模拟手术辅助寰枢椎置钉治疗Ⅱ型齿突骨折

目的探讨3D打印、逆向工程技术结合体外模拟手术辅助寰枢椎置钉治疗Ⅱ型齿突骨折的准确性和安全性。方法回顾性分析2010年1月—2018年3月接受椎弓根螺钉内固定治疗的23例Ⅱ型齿突骨折患者临床资料。其中12例常规徒手置入C_(1,2)椎弓根螺钉(徒手组);11例在利用3D打印和逆向工程技术实施体外模拟手术成功后,术中利用导航模板辅助置入C_(1,2)椎弓根螺钉(导航组)。记录手术时间、术中出血量、住院时间及置钉偏差率。手术前后采用疼痛视觉模拟量表(VAS)评分和美国脊髓损伤协会(ASIA)分级评估疗效。结果所有手术顺利完成,术中无脊髓损伤、椎动脉损伤等严重并发症发生。所有患者随访超过6个月。导航组手术时间、术中出血量及置钉偏差率均低于徒手组,差异均有统计学意义(P 0.05)。2组术后6个月VAS评分均较术前显著改善,差异有统计学意义(P 0.05),组间比较差异无统计学意义(P 0.05)。徒手组术前ASIA分级D级4例、E级8例,导航组术前D级3例、E级8例,术后均为E级。结论 3D打印、逆向工程技术结合体外模拟手术辅助寰枢椎置钉治疗Ⅱ型齿突骨折,置钉方案完全个性化,提高了置钉的准确性和安全性,是一种安全有效的辅助置钉手段。     

椎弓根螺钉固定治疗Hangman 骨折

目的 探讨C2椎弓根螺钉在治疗Hangman骨折中应用效果。方法 8例均于颅骨牵引复位后行C2椎弓根螺钉内固定治疗。结果 8例均获随访，随访时间2～8个月，平均6个月。其中6例骨性愈合，2例仍在随访中。无感染、神经损伤等并发症发生。结论 应用C2椎弓根螺钉治疗Hangman骨折是一种有效、安全并能最大程度保留患者颈部功能的较好方法。     

C2～3椎弓根-侧块螺钉系统治疗不稳定型Hangman骨折

目的探讨C2～3椎弓根-侧块螺钉系统治疗Hangman骨折的疗效及临床效果。方法我院2007年4月至2010年10月收治的11例Hangman骨折患者进行回顾性研究,男4例,女7例;年龄22～61岁,平均42.5岁。患者均表现为颈痛、颈部活动受限,2例单侧上肢,1例双侧上肢麻木无力。所有患者入院后均行X线、三维CT及MRI检查,并测量C2～3椎体移位和成角,其中Levine-Edwards分型,Ⅰ型3例,Ⅱ型4例,Ⅱa型2例,Ⅲ型2例。入院后常规行颅骨牵引,Ⅰ型患者予以halo-vest架外固定治疗,Ⅱ型、Ⅱa型、Ⅲ型患者行后路C2～3椎弓根侧块螺钉内固定术,术后用费城颈托保护6周。结果随访2～44个月,平均20.6个月。平均6个月时骨折端愈合,颈痛、肢体麻木等症状消失,但颈部活动度较正常略有下降,无内固定失败及感染等并发症发生。结论经后路C2～3椎弓根侧块螺钉系统是治疗Hangman骨折的良好手术方式。     

不稳定Hangman骨折的手术治疗

目的 探泔颈椎后路椎弓根螺钉内同定治疗不稳定Hangman骨折的临床效果.方法 2001年10月至2006年4月收治15例不稳定Hangman骨折患者,骨折按照Levine-Edwards分型:Ⅱ犁3例,ⅡA型4例,Ⅲ型8例.入院后均给予颅骨牵引,行颈后路切开复位、椎弓根螺钉内固定术治疗.在复位不完全时,脱位不严重者采用C2.3复位固定;脱位严重时,在C<.2>椎弓根钉和C3侧块螺钉固定的基础上,增加C4的侧块螺钉固定.结果 术后随访3～30个月,平均17个月.6例术前脊髓功能Frankel分级为D级的患者术后恢复至E级,所有患者术后复奋X线片示:骨折全部获得骨件愈合,无明显的颈椎功能受限.结论 C2.3或C2-4后路椎弓根螺钉内固定手术是治疗不稳定Hangman骨折的有效方法,可达到早期复位、坚强同定的目的 .     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.