经常规前路间盘切除植骨融合治疗Hangman骨折

目的 探讨经前路间盘切除植骨融合治疗Hangman骨折的治疗结果和治疗特点.方法 对天津医院脊柱外科2005年6月至2008年12月诊治的36例Hangman骨折患者进行回顾性分析.所有患者均行X线片、CT和MRI检查.其中手术治疗27例患者,按照Levine-Edwards分型标准:Ⅱ型17例,Ⅱa型10例.在全麻下行常规颈前方入路显露C2-3椎体,切除C2-3椎间盘组织,充分减压,取自体髂骨植骨及钢板固定.术后颈托保护4周,对手术时间、住院时间、并发症、合并症、神经恢复情况及融合率做评估.结果 27例手术患者均获随访,平均随访15(10～36)个月.无一例出现椎体再移位和成角畸形.术前疼痛均获得缓解,术前神经功能障碍获得改善.未发现脊髓损伤、椎动脉损伤、脑脊液漏等并发症,没有发生与内植物相关的并发症,手术时间和住院时间与下颈椎手术时间相似,所有患者6个月内完全融合.结论 经常规颈前路C2-3间盘摘除植骨融合钢板内固定治疗Hangman骨折疗效确切,安全可行.

Anterior cervical discectomy and fusion in the treatment of Hangman's fracture

Objective To evaluate the efficacies and features of treating Hangman's fracture by anterior cervical discectomy and fusion (ACDF). Methods Since June 2005 to December 2008, 36 cases with Hangman's fracture were analyzed with their clinical data including history, symptoms, signs,radiological findings and treatments. According to the classification system designed by Levine and Edwards depending on the radiological manifestations of Hangman's fractures, they were subdivided into type Ⅰ ( n =9) (conservative therapy), type Ⅱ (n = 17) and type ⅡA (n = 10). Conservative therapy was offered to type Ⅰ in 9 cases, while ACDF with cervical gear protection for 4 weeks after surgery was performed to type Ⅱ in 17 cases and type Ⅱ A in 10 cases. A combination of operation time, days of hospitalization,complications, neurological improvement and fusion rate was assessed. Results An average follow-up of 15months (range: 10 -36) was achieved. No vertebral redisplacement and angulation deformity occurred.Axial pain was relieved in each case. The preoperative neurological deficits in all patients got improvements. No spinal cord injury, vertebral artery injury or cerebrospinal fluid leakage ocurred. No complication related to internal fixator was found. Average operative time and hospitalization were similar to those of ACDF for lower cervical spine(98 minutes vs. 9 days). Fusion was achieved within 6 months in all cases. Conclusion ACDF at C2-C3 may be an effective and safe way to treat Hangman's fracture.