C2-3后路钉棒固定联合枢椎棘突肌肉血管复合体移植治疗不稳定型Hangman骨折

C2-3 posterior screw-rod fixation combined with C2 spinous process-muscle-vascellum complex transplantation for unstable Hangman fracture

中文关键词:  Hangman骨折  C2棘突  肌肉血管  植骨

英文关键词:Hangman fracture  C2 spinous process  Muscle-vascular  Bone graft

中文摘要:

  【摘要】 目的：探讨C2-3后路钉棒固定联合枢椎棘突肌肉血管复合体移植治疗不稳定型Hangman骨折的临床疗效。方法：2014年9月~2015年8月，对7例不稳定型Hangman骨折患者行C2-3内固定椎间融合术，男5例，女2例，年龄27~62岁（平均43±12.7岁），Hangman Ⅱ型骨折6例，ⅡA型骨折1例。术前均行X线片、CT和MRI检查。7例患者均行C2-3后路椎弓根钉棒固定联合枢椎棘突肌肉血管复合体骨移植术。术后和随访时均行颈椎动力位X线片和CT检查观察骨折复位和愈合情况，术前、术后采用JOA（Japanese Orthopedic Asscciation）评分及轴性症状等级评估患者神经功能和症状。结果：所有患者均获得随访，随访时间为9~15个月，平均为10.5±1.6个月。术后X线片和CT显示所有患者复位满意，随访期间无复位丢失、内固定失败及螺钉松动，动力位X线片未见失稳出现；末次随访CT示植骨块连续性骨小梁通过，达到骨性融合，骨性融合时间为5~10个月（7.1±1.3个月），术后1周和6个月时的JOA评分改善率分别为（23.1±10.5）%和（50.2±15.7）%。术后轴性症状3例为优，4例为良。结论：C2-3后路椎弓根钉棒固定联合枢椎棘突肌肉

英文摘要:

  【Abstract】 Objectives: To assess the clinical outcomes of C2-3 posterior screw-rod fixation combined with C2 spinous process-muscle-vascellum complex transplantation for unstable Hangman fracture. Methods: The study included 7 cases of unstable Hangman fracture treated between September 2014 and August 2015. There were 5 males and 2 females whose age ranged from 27 to 62 years old(mean, 43±12.7 years old). Six cases were diagnosed with Hangman Ⅱ fracture and one case was Hangman ⅡA fracture. X-ray, CT scan reconstruction and MRI were evaluated before operation. All the patients were treated with one stage C2-3 posterior screw-rod fixation combined with C2 spinous process-muscle-vascellum complex transplantation. Preoperative and postoperative Japanese Orthopedic Association(JOA) scores, the degree of axial symptom were recorded and compared. Results: All the patients were followed up. The follow-up time ranged from 9 to 15 months(mean, 10.5±1.6 months). Postoperative cervical spine X-ray and CT showed that the cervical spine alignment was restored. The dynamic X-ray showed no instability of cervical spine. The time of bone fusion in CT scan ranged from 5 to 10 months(mean, 7.1±1.3 months). The improvement rate of JOA scores at 1 week after operation of (23.1±10.5)% was significantly smaller than that at 6 months after operation of (50.2±15.7)%. The results of axial symptom was satisfactory in 4 patients and acceptable in 3 patients. Conclusions: The C2-3 posterior screw-rod fixation combined with C2 spinous process-muscle-vascellum complex transplantation for unstable Hangman fracture is effective. This procedure can preserve muscle intact and cervical stability.