创伤性枢椎滑脱的临床诊治分析

目的 探讨创伤性枢椎滑脱(Hangman骨折)的损伤机制、临床表现及治疗方法。方法 回顾1988年6月-2001年3月收治的hangman骨折患者10例,对其影像学表现、损伤机制及治疗方法进行分析。结果 10例患者男9例,女1例,平均年龄40岁,致伤原因为车祸7例,原木砸伤颈部1例,高处坠落1例,另1例患强直性脊柱炎因摔跤致伤,其中Ⅰ型1例,Ⅱ型5例,Ⅱa型2例,Ⅲ型2例;4例保守治疗,6例手术治疗。结论 车祸和坠落为创伤性枢椎滑脱的主要致伤因素,其临床表现多为颈椎局部疼痛、拒动等症状,少有神经系统的损伤;影像学诊断依据颈椎侧位X光片和颈椎CT;创伤性枢椎滑脱Ⅰ型、Ⅱ型及Ⅱa型可保守治疗,Ⅲ型和伴有C2-3间盘突出损伤脊髓的患者应采取手术治疗。

Clinical diagnosis and treatment of Hangman's fracture

OBJECTIVE: To investigate the mechanism of Hangman's fracture and its clinical manifestation and treatment. METHODS: Ten patients with Hangman's fracture treated at our hospital from 1988 to 2001 were analysed. RESULT: Patients were injured by motor vehicle accidents (7 patients), object hitting on the head (1), and fall (1). Injuries were classified as type I (1 patient), type II (5), type IIa (2) and type III (2). CONCLUSIONS: Motor vehicle accident and fall are major causes of Hangman's fracture with neurological deficits but limited motion and neck pain. Hangman's fracture is easily diagnosed using lateral cervical X-ray and CT. Hangman's fractures of types I, II and IIa can be treated conservatively, but those of type III or spinal cord injury require surgical stabilization.