Hangman骨折的手术策略

目的探讨Hangman骨折的手术策略。方法回顾性分析18例患者，结合影像学表现确定损伤类型，依据不同的分型、损伤机制及椎间盘损伤程度选择不同的手术方法。Ⅰ型1例（保守治疗3个月后出现C。椎间盘退变，椎间失稳）、Ⅱ型5例、Ⅱa型4例、Ⅲ型2例共12例行颈椎椎弓根侧块螺钉联合内固定融合术；Ⅱ型3例、Ⅱa型2例共5例行前路植骨融合钢板内固定术；Ⅲ型l例后路手术术后3个月复查发现C2-3不稳，予前路酝修手术。结果元相关术中并发症。所有患者随访8～30个月，平均22个月，骨折均获得骨性愈合，未出现颈椎不稳和螺钉松动。结论Ⅱ型、Ⅱa型、Ⅲ型应及早手术，Ⅰ型非手术治疗后因椎间盘退变造成椎间不稳者亦应手术治疗。根据不同的骨折分型、损伤机制及椎间盘损伤程度来选择手术术式均能获得满意疗效。

Surgical strategy for Hangman's Fractures

Objective To explore the surgical strategy of Hangman’s fractures. Methods Eighteen patients (including 11 males and 7 females) received different surgical methods depending on the fracture type, biomechanical patterns of injury and the degree of injury of intervertebral disc. One case of Type Ⅰwas managed with traction followed by bracement, and then treated with posterior C2 pedicle screw combined with C3 lateral mass inner immobilization three months later because of C2~3 disc degenerative and instability. Another 11 cases (5 cases of type Ⅱ, 4 cases of type Ⅱa and 2 cases of type Ⅲ) were treated with posterior C2 pedicle screw combined with C3 lateral mass inner immobilization. Five cases (3 cases of type Ⅱ and 2 cases of type Ⅱa) were treated with anterior inner fixation and fusion with bone graft. One case of type Ⅲ, found instability between C2~3 three months after posterior procedure, was treated with anterior inner fixation and fusion. Results No intraoperative complications were observed. All the patients were followed up for 8~30 months (with an average of 22 months) postoperatively, All the patients achieved solid bone fusion and excellent clinical results without cervical spinal instability and lag screws loosing. Conclusion Patients with type Ⅱ or type Ⅱ or type Ⅲ Hangman’s fractures should be treated by surgery as early as possible. Patients with type Ⅰ Hangman’s fractures found with C2~3 disc degeneration and instability after conservative management should be also treated with surgery. Satisfactory results can be achieved by taking surgical methods according to the fracture type, biomechanical patterns of injury and the degree of injury of intervertebral disc.