高位颈前入路复位固定治疗Ⅱ型及ⅡA型Hangman骨折

摘要

目的：评价高位颈前入路复位固定治疗Ⅱ型及ⅡA型Hangman骨折的临床疗效。方法对2005年1月至2013年5月中山大学第一附属医院收治的21例Ⅱ型及ⅡA型Hangman骨折患者行高位颈前入路C2～C3椎间盘切除、复位及融合固定手术。记录手术时间、术中出血量，测量术后1周及末次随访时C2～C3前凸角；观察复位及并发症发生情况。结果手术时间50～90 min（平均75 min）；术中出血量20～100 mL（平均55 mL）。术中无神经血管损伤并发症，所有患者成功获得固定。19例C2前脱位患者中，16例获得完全复位；3例基本复位。术后1周C2～C3平均前凸角为（3.1±0.8）°，优于术前的（-9±2.5）°（P＜0.05）；19例患者获得平均3年3个月（6个月至7年）的有效随访，末次随访时C2～C3平均前凸角为（2.6±0.5）°，未有明显丢失。所有患者获得椎间融合，未出现内固定松动、脱出、断裂等并发症。结论高位颈前入路C2～C3椎间盘切除、复位及融合固定治疗Ⅱ型及ⅡA型Hangman骨折，复位理想，内固定牢靠，能有效纠正和维持患者的颈椎前凸，融合率高，疗效满意。%Objective To evaluate the clinical effects of reduction and fixation by high anterior cervical approach for treatment of type II and type IIA Hangman's fractures. Methods From January 2005 to May 2013, 21 patients with type II and type IIA hangman's fractures underwent C2-C3 discectomy, reduction and intervertebral fusion with internal fixation by high anterior cervical approach. The operative time and intraoperative estimate blood loss were recorded, C2-C3 lordosis angles at one week postoperatively and the final follow-up were determined respectively, and the reduction and complications were observed. Results The average operative time was 75 min (50-90 min), the intraoperative estimate blood loss was 20-100 mL, with the average of 55 mL. No intraoperative complications such as nerve or blood vessel injuries were observed. All patients achieved fixation successfully, and for 19 patients with anterior dislocation of C2, 16 patients achieved completely anatomic reduction and 3 of them functional reduction. The average angles of lordosis in C2-C3 at preoperation and postoperation were (-9 ± 2.5)° and (3.1 ± 0.8)° respectively which had statistical differences (P <0.05). Total of 19 patients were followed up with the average time of 3 years and 3 months (6 months to 7 years). The average angle of lordosis in C2-C3 at the last follow-up was (2.6 ± 0.5)°, no obvious loss of angle of lordosis were observed. Radiological results showed evidences of a solid C2-C3 intervetebral fusion. No internal fixation hardware loosening, pull-out or breakage were found during the follow-up. Conclusions Treatment of C2-C3 discectomy, reduction and fusion with internal fixation by high anterior cervical approach for type II and type IIA Hangman's fractures can improve and then maintain the angles of cervical lordosis, achieve satisfactory reduction, reliable fixation and fusion, and therefore good clinical effects.