前路椎间融合治疗合并椎间盘损伤的不稳定Hangman骨折19例临床分析

目的探讨合并椎间盘损伤的不稳定Hangman骨折的外科治疗方法及价值.方法19例不稳定Hangman骨折伴C2～3椎间盘损伤,行颈椎前路C2～3椎间隙融合、颈前路钛板固定术,其中12例植入cage,7例取自体髂骨植骨.结果随访2～5 a,平均2 a 8个月,所有病例颈痛症状消失;术后3～6个月C2～3获得骨性融合,3例出现喉上神经损伤,2月后恢复;颈部血肿3例,经清创引流后愈合;1例出现颌下腺瘘,经换药,高压氧治疗后痊愈;未出现神经症状加重、植骨块移位、吸收和切口感染等并发症.结论颈前路融合钢板内固定术是治疗不稳定Hangman骨折较为理想的方法,但手术并发症需引起重视,应积极预防并进行相应处理.

Anterior Intervertebral Fusion for the Treatment of Unstable Hangman's Fracture Combined with Intervertebral Disc Injury

Objective To explore the Surgical treatment and value of unstable Hangman＇s fracture combined with intervertebral disc injury.Methods The study involved 19 patients with unstable Hangman＇s fracture with C2,3 intervertebral disc injury treat with anterior cervical C2～3 intervertebral fusion,anterior cervical plate fixation.There were 12 patients who were implanted cage,7 patients with Implantation of autologous iliac bone.Results All patients were followed up for 2～5 years（average 2 years and 8 months）,and neck pain symptoms disappeared.Three patients appeared Laryngeal nerve injury and recovered after two months.Neck hematoma appeared in 3 patients who were cured after debridement and drainage.One patient was with submandibular gland fistula and recovered after dressing,hyperbaric oxygen therapy.There was no patients appear neurological symptoms become worsen,graft displacement or absorption,and wound infection.Conclusions Anterior cervical fusion with plate fixation is an ideal method for the treatment of unstable Hangman＇s fracture.However,the complications need to pay attention,and shouldbe actively prevented and handled accordingly.