Hangman骨折的治疗方法选择及疗效分析

Selection of therapeutic methods and clinical results of Hangman′s fractures

中文关键词:  Hangman骨折  颈椎  治疗  疗效

英文关键词:Hangman fracture  Cervical vertebrae  Treatment  Outcome

中文摘要:

  【摘要】 目的：探讨不同类型Hangman骨折的治疗方法选择和治疗效果。方法：2006年1月~2009年6月我院脊柱外科共收治Hangman骨折患者29例，男20例，女9例；年龄17～74岁，平均32岁。采用Levine-Edwards分类法：Ⅰ型8例，Ⅱ型12例，Ⅱa型7例，Ⅲ型2例。所有患者均先行牵引复位后再采用Halo-vest外固定或手术内固定治疗，其中Ⅰ型患者均采用Halo-vest外固定；有硬膜前方受压的5例Ⅱ型和1例Ⅲ型患者采用前路C2/3椎间盘摘除、椎体间植骨、前路钛板固定术（A术式），无硬膜前方受压的5例Ⅱa型患者采用后路C2椎弓根螺钉固定术（B术式），2例Ⅱa型、7例Ⅱ型、1例Ⅲ型患者采用后路C2-3椎弓根侧块螺钉钛板/棒内固定术（C术式）。术后根据颈椎X线片上骨折愈合情况、临床症状及颈椎活动功能改善情况评价各种治疗方法的疗效。结果：术后随访6~40个月，平均18个月。末次随访时8例采用Halo-vest外固定治疗的Ⅰ型患者疗效优良5例，可2例，差1例（骨折未愈合，后经A术式治疗，12周后C2-3节段融合，疗效为良）。6例A术式及5例B术式手术患者均在12周后获得骨性融合，疗效均为优良。10例采用C术式手术患者中，1例Ⅱ型患者畸形融合，1例Ⅱ型未融合，8例疗效优良。结论：根据Levine-Edwards分型选择治疗方式治疗Hangman骨折多数患者可获得优良疗效。

英文摘要:

  【Abstract】　Objective：To explore the selection of therapeutic methods and clinical results of Hangman fracture through choosing reasonable treatment methods according to different fracture types.Method：All 29 cases with Hangman fractures were admitted to our hospital from Jan 2006 to Jun 2009.20 cases are male，and 9 cases are female.The age is from 17 to 74 years old.The average age is 32 years.According to Levine-Edwards typing：8 cases with type Ⅰ，12 cases with type Ⅱ，7 cases with type Ⅱa，2 cases with type Ⅲ.All the patients had Halo-vest or operation after tractionreduction.Type Ⅰ cases underwent Halo-vest.5 cases with type Ⅱ and 1 with type Ⅲ with compression on ventral dural sac were managed with anterior approach combined with intervertebral disc resection of C2-3 and bone grafting，plate internal fixation（the way of operation A）.5 type Ⅱa cases without compression were treated with posterior pedicle screw fixation at C2（the way of operation B）.2 cases with type Ⅱa and 7 cases with type Ⅱ and 1 case with type Ⅲ were managed with posterior C2-3 bone grafting fusion and screw-plate/stick fixation（the way of operation C）.According to the X-ray of cervical vertebra，clinical symptom，activity function of cervical vertebra to evaluate the treatment results.Result：All cases were followed up for 6-40 months.The average is 18 months.Of 8 cases with Halo-vast treatment，5 cases showed union of fracture at 12 weeks with excellent curative effect，2 cases acceptable，and 1 case bad（There was nonunion of fracture，then it was treated with the way of operation A.12 weeks later，it showed C2-3 bone grafting fusion and got good effect assessment）.All 6 cases with the way of operation A and 5 type Ⅱa cases with the way of operation B showed C2-3 bone grafting fusion after 12 weeks.Among 10 cases treated with the way of operation C，1 type Ⅱ developed nonunion，1 type Ⅱ had malunion，and 8 cases had union.Conclusion：Most patiens who had Hangman fracture through different treatment ways can get good treatment effect according to Levine-Edwards typing.