颈椎前路融合钢板内固定治疗不稳定Hangman骨折

目的探讨Hangman骨折损伤的病理特点、颈椎前路手术疗效和并发症的防治。方法对18例不稳定Hangman骨折患者行C2～3前路减压、椎间隙植骨融合、颈椎前路自锁钢板内固定术。结果18例均获随访,时间6～18（12±6）个月。术后3～6个月均获骨性愈合。神经功能恢复情况：C级3例恢复至D级1例、E级2例;D级9例全部恢复至E级。16例颈痛症状消失,2例有轻度颈痛症状。5例出现并发症,其中喉上神经损伤2例,食管损伤1例,颈部切口血肿1例,下肢深静脉血栓形成1例。结论颈前路融合钢板内固定术是治疗不稳定Hangman骨折的理想方法,但手术并发症需引起重视,应积极预防并进行相应处理。

Anterior cervical fusion and plate fixation for unstable Hangman's fractures

Objective To discuss the traumatic pathologic feature of Hangman′s fractures and the effects and complications of the anterior surgical treatment.Methods Eighteen patients with unstable Hangman′s fracture underwent anterior cervical fusion and internal fixation with self-locking plate between C 23 .Results All patients had been followed up for 618（12±6） months. All patients achieved a stable bony fusion and patients with incomplete spinal cord injury improved in different degree within 36 months postoperatively. According to ASIA neurologic grading system,one of 3 cases in grade C recovered to grade D and all of the 9 cases in grade D recovered to grade E postoperatively.Cervical pain disappeared in 16 patients and remained slight in 2 patients. Five patients had complications included superior laryngeal nerve injury in 2,esophageal injury in 1,intra-incision hematoma in 1 and deep venous thrombosis of lower extremity in 1.Conclusions Anterior cervical fusion and plate fixation may be effective for unstable Hangman′s fractures. Adequate attention must be paid to prevent and manage the complications.