应用Solis融合器置入治疗Ⅱ型及Ⅱa型Hangman骨折的临床疗效

Clinical outcomes of Solis implantation for typeⅡ and Ⅱa Hangman′s fractures

中文关键词:  颈椎  Hangman骨折  椎间融合术  内固定器

英文关键词:Cervical vertebrae  Hangman′s fracture  Intervertebral fusion cage  Internal fixation

中文摘要:

  【摘要】 目的：评价Solis椎间融合器置入治疗Ⅱ型及Ⅱa型Hangman骨折的临床疗效。方法：2006年1月～2011年11月，我科采用经前路Solis椎间融合器置入治疗Ⅱ型及Ⅱa型Hangman骨折患者17例，术中应用颈椎牵开器牵开椎间，通过紧张韧带进一步复位骨折。其中男11例、女6例，年龄19～41岁，平均26.2岁，按Levine-Edwards分类法Ⅱ型11例，Ⅱa型6例。于术后1周、3个月、6个月及末次随访时复查X线片，记录术前及末次随访时的枢椎移位及成角数据，记录术前及末次随访时的创伤后颈椎临床评分、颈部疼痛的VAS评分观察临床疗效。术前与末次随访时各数据间行t检验。结果：手术时间平均为78min（55～135min）；术中出血量平均为22.5ml（10～50ml）。术中无喉上神经、咽喉壁及血管损伤，术后无喉头水肿、血肿形成及伤口感染等手术并发症。平均随访25.1个月（6～48个月），手术节段及骨折部位平均于3个月时骨性融合，未见畸形愈合，末次随访时融合器无下沉、无移位、椎间无塌陷。创伤后颈椎临床评分：术前平均为48分（45～63分），末次随访时为92分（83～97分）；颈部疼痛VAS评分术前平均为6.9分（6～9分），末次随访时为1.1分（0～2分）；枢椎成角术前平均为－8.6°（－20～6°），末次随访时为＋3.5°（0～+8°）；枢椎移位术前平均为3.4mm（1～5.5mm），末次随访时为1.2mm（0～2.0mm）。以上两组数据间差异均有统计学意义（P＜0.05)。结论：应用Solis椎间融合器置入治疗Hangman骨折可行，手术操作简单、耗时短、创伤小、融合率高且有利于颈椎稳定。

英文摘要:

  【Abstract】 Objectives： To investigate the clinical outcomes of Solis implantation for type Ⅱ and Ⅱa Hangman′s fractures. Methods： From January 2006 to November 2011, a total of 17 cases with type Ⅱ and Ⅱa Hangman′s fractures underwent anterior Solis placement. There were 11 males and 6 females, with the average age of 26.2 (range, 19-41). The reduction was achieved by distracting the intervertebral space and strengthening the tension of ligaments during operation. X-ray radiograph was taken at 1 week, 3 month, 6 months and final follow-up. The angular variation and translational displacement at pre-operative and final follow-up were recorded, and the clinical post-traumatic neck score as well as neck pain VAS score were recorded and analyzed. Results： The average operative time was 78min (55-135min) and blood loss was 22.5mL (10-50 mL). There was no surgical-related complication such as neurovascular or pharynx injury. No laryngeal edema, haematoma or infection was noted either. All patients were followedup for an average of 25.1 months (range 6-48 months), and the solid fusion was evidenced 3 months later, no cage related complications were observed. The clinical post-traumatic neck score (Mayo) was 48 (range 45-63) and 92 (range 83-97) for preoperation and final follow-up respectively; the neck pain VAS score was 6.9 (range 6-9) and 1.1 (range 0-2) for preoperation and final follow-up respectively; the angular variation was -8.6° (range -20-6°) and +3.5° (range 0-8°) for preoperation and final follow-up respectively; the translational displacement was 3.4 mm (range 1-5.5mm) and 1.2mm (range 0-2.0mm) for preoperation and final follow-up respectively. There were significant differences between the data of preoperation and final followup(P<0.05). Conclusions： The implantation of Solis for typeⅡ and Ⅱa Hangman′s fractures is feasible, simple and minimal invasive, which promises the stability of cervical spine.