前路椎间植骨融合内固定术治疗Hangman骨折的临床效果观察
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摘要
目的观察前路椎间植骨融合内固定术治疗Hangman骨折的临床效果。方法回顾分析2010年5月—2016年5月期间因Hangman骨折接受前路椎间植骨融合内固定术的患者共41例,通过影像学资料评价术后椎间植骨愈合情况,采用疼痛视觉模拟评分(Visual Analogue Scale,VAS)、颈椎功能障碍指数量表(Neck Disability Index,NDI)和改良日本骨科协会评分(Modified Japanese Orthopaedic Association Scale,m-JOA)评定患者症状改善情况,同时评估手术并发症的发生情况。结果患者术后无严重并发症发生,5例患者出现一过性吞咽不适、饮水呛咳,并自发缓解。35例患者在术后3个月观察到椎间植骨已融合,其余6例在末次随访时均观察到椎间植骨已融合。患者术前VAS评分为(4.5±1.6)分,术后即刻降低至(2.4±1.7)分(P>0.05),末次随访时进一步降低至(0.7±0.9)分(P<0.05);患者术前NDI评分为(29.3±10.9)分,术后即刻降低至(13.2±5.4)分(P<0.05),末次随访时进一步降低至(4.6±3.1)分(P<0.05);患者术前m-JOA评分为(8.4±2.3)分,术后即刻提高至(11.6±3.5)分(P<0.05),末次随访进一步改善为(14.3±2.0)分(P<0.05)。结论采用前路椎间植骨融合内固定术治疗Hangman骨折可以取得较为满意的临床效果。
Objective To observe the clinical outcomes of Hangman fracture treated by anterior cervical discectomy and fusion. Methods A total of 41 patients with Hangman fracture were retrospectively analyzed, who underwent anterior cervical discectomy and fusion from May 2010 to May 2016. Intervertebral bone graft fusion was observed through postoperative radiographic images, and improvement of symptoms was evaluated by Visual Analogue Scale(VAS), Neck Disability Index(NDI) and Modified Japanese Orthopaedic Association Scale(m-JOA). Surgical complications were evaluated as well. Results No severe complications occurred after surgery, but 5 patients had a transient dysphagia, which relieved spontaneously. Thirty-five patients had a fusion of intervertebral bone graft3 months after surgery, and the remaining 6 patients did at the last follow-up. The VAS score was improved from 4.5±1.6 pre-operatively to 2.4±1.7 immediately post-operatively(P>0.05), and was further improved to 0.7±0.9 at the last followup(P<0.05). The NDI score was improved from 29.3±10.9 pre-operatively to 13.2±5.4 immediately post-operatively(P<0.05), and was further improved to 4.6±3.1 at the last follow-up(P<0.05). The m-JOA score was improved from8.4±2.3 pre-operatively to 11.6±3.5 immediately post-operatively(P<0.05), and was further improved to 14.3±2.0 at the last follow-up(P<0.05). Conclusion Anterior cervical discectomy and fusion can be used in Hangman fracture, which is safe and reliable.
Objective To observe the clinical outcomes of Hangman fracture treated by anterior cervical discectomy and fusion. Methods A total of 41 patients with Hangman fracture were retrospectively analyzed, who underwent anterior cervical discectomy and fusion from May 2010 to May 2016. Intervertebral bone graft fusion was observed through postoperative radiographic images, and improvement of symptoms was evaluated by Visual Analogue Scale(VAS), Neck Disability Index(NDI) and Modified Japanese Orthopaedic Association Scale(m-JOA). Surgical complications were evaluated as well. Results No severe complications occurred after surgery, but 5 patients had a transient dysphagia, which relieved spontaneously. Thirty-five patients had a fusion of intervertebral bone graft3 months after surgery, and the remaining 6 patients did at the last follow-up. The VAS score was improved from 4.5±1.6 pre-operatively to 2.4±1.7 immediately post-operatively(P>0.05), and was further improved to 0.7±0.9 at the last followup(P<0.05). The NDI score was improved from 29.3±10.9 pre-operatively to 13.2±5.4 immediately post-operatively(P<0.05), and was further improved to 4.6±3.1 at the last follow-up(P<0.05). The m-JOA score was improved from8.4±2.3 pre-operatively to 11.6±3.5 immediately post-operatively(P<0.05), and was further improved to 14.3±2.0 at the last follow-up(P<0.05). Conclusion Anterior cervical discectomy and fusion can be used in Hangman fracture, which is safe and reliable.
引文
1Schneider RC,Livingston KE,Cave AJ,et al.“Hangman’s fracture”of the cervical spine.J Neurosurg,1965,22:141-154.
2 Effendi B,Roy D,Cornish B,et al.Fractures of the ring of the axis.A classification based on the analysis of 131 cases.J Bone Joint Surg(Br),1981,63-B(3):319-327.
3Levine AM,Edwards CC.The management of traumatic spondylolisthesis of the axis.J Bone Joint Surg Am,1985,67(2):217-226.
4 Liu J,Li Y,Wu Y.One-stage posterior C2 and C3 pedicle screw fixation or combined anterior C2-C3 fusion for the treatment of unstable hangman’s fracture.Exp Ther Med,2013,5(3):667-672.
5孙厚杰,蔡小军,张军,等.Hangman骨折的治疗方法选择及疗效分析.中国脊柱脊髓杂志,2011,21(7):554-560.
6 王清,王松,钟德君,等.不稳定性Hangman骨折手术入路选择.中国脊柱脊髓杂志,2012,22(6):526-530.
7陈建明,张成程,庄颖,等.不同后路短节段内固定治疗Hangman骨折.中华创伤杂志,2013,29(7):623-625.
8 Vender JR,Harrison SJ,Mc Donnell DE.Fusion and instrumentation at C1-3 via the high anterior cervical approach.Spine,1999,24(3):295-299.
9谭明生,董亮.对上颈椎损伤治疗原则的探讨.中国脊柱脊髓杂志,2013,23(5):387-388.
10 Rajasekaran S,Tubaki VR,Shetty AP.Results of direct repair of type 2 hangman fracture using Iso-C3D navigation:20 cases.J Spinal Disord Tech,2012,25(5):E134-E139.
11葛朝元,郝定均,贺宝荣,等.颈前路钢板内固定治疗不稳定Hangman骨折的疗效分析.中国修复重建外科杂志,2014,28(6):728-732.
12 蔡贤华,陈庄洪,黄继锋,等.Hangman骨折损伤病理特点及颈前路钢板内固定治疗.临床外科杂志,2007,15(5):349-351.
13Watanabe M,Nomura T,Toh E,et al.Residual neck pain after traumatic spondylolisthesis of the axis.J Spinal Disord Tech,2005,18(2):148-151.
14 马毅,邓树才,刘建坤,等.经常规前路间盘切除植骨融合治疗Hangman骨折.中华医学杂志,2010,90(35):2451-2454.
15Muthukumar N.C1-C3 lateral mass fusion for typeⅡa and typeⅢHangman’s fracture.J Craniovertebr Junction Spine,2012,3(2):62-66.
16 Ma W,Xu R,Liu J,et al.Posterior short-segment fixation and fusion in unstable Hangman’s fractures.Spine(Phila Pa 1976),2011,36(7):529-533.
17Shin JJ,Kim SJ,Kim TH,et al.Optimal use of the halo-vest orthosis for upper cervical spine injuries.Yonsei Med J,2010,51(5):648-652.
18 Elmiligui Y,Koptan W,Emran I.Transpedicular screw fixation for typeⅡHangman’s fracture:a motion preserving procedure.Eur Spine J,2010,19(8):1299-1305.
19Wu YS,Lin Y,Zhang XL,et al.Management of Hangman’s fracture with percutaneous transpedicular screw fixation.Eur Spine J,2013,22(1):79-86.
20 Rayes M,Mittal M,Rengachary SS,et al.Hangman’s fracture:a historical and biomechanical perspective.J Neurosurg Spine,2011,2:198-208.
21张来仁,董宏袆,王世印.前路或后路手术治疗Hangman骨折的影响因素分析及临床疗效观察.中国矫形外科杂志,2015,23(4):313-317.
22 李金泉,徐皓,姚晓东,等.两种不同手术入路治疗不稳定Hangman骨折的比较.中国矫形外科杂志,2010,18(4):280-283.
23Abumi K,Shono Y,Ito M,et al.Complications of pedicle screw fixation in reconstructive surgery of the cervical spine.Spine,2000,8:962-969.
2 Effendi B,Roy D,Cornish B,et al.Fractures of the ring of the axis.A classification based on the analysis of 131 cases.J Bone Joint Surg(Br),1981,63-B(3):319-327.
3Levine AM,Edwards CC.The management of traumatic spondylolisthesis of the axis.J Bone Joint Surg Am,1985,67(2):217-226.
4 Liu J,Li Y,Wu Y.One-stage posterior C2 and C3 pedicle screw fixation or combined anterior C2-C3 fusion for the treatment of unstable hangman’s fracture.Exp Ther Med,2013,5(3):667-672.
5孙厚杰,蔡小军,张军,等.Hangman骨折的治疗方法选择及疗效分析.中国脊柱脊髓杂志,2011,21(7):554-560.
6 王清,王松,钟德君,等.不稳定性Hangman骨折手术入路选择.中国脊柱脊髓杂志,2012,22(6):526-530.
7陈建明,张成程,庄颖,等.不同后路短节段内固定治疗Hangman骨折.中华创伤杂志,2013,29(7):623-625.
8 Vender JR,Harrison SJ,Mc Donnell DE.Fusion and instrumentation at C1-3 via the high anterior cervical approach.Spine,1999,24(3):295-299.
9谭明生,董亮.对上颈椎损伤治疗原则的探讨.中国脊柱脊髓杂志,2013,23(5):387-388.
10 Rajasekaran S,Tubaki VR,Shetty AP.Results of direct repair of type 2 hangman fracture using Iso-C3D navigation:20 cases.J Spinal Disord Tech,2012,25(5):E134-E139.
11葛朝元,郝定均,贺宝荣,等.颈前路钢板内固定治疗不稳定Hangman骨折的疗效分析.中国修复重建外科杂志,2014,28(6):728-732.
12 蔡贤华,陈庄洪,黄继锋,等.Hangman骨折损伤病理特点及颈前路钢板内固定治疗.临床外科杂志,2007,15(5):349-351.
13Watanabe M,Nomura T,Toh E,et al.Residual neck pain after traumatic spondylolisthesis of the axis.J Spinal Disord Tech,2005,18(2):148-151.
14 马毅,邓树才,刘建坤,等.经常规前路间盘切除植骨融合治疗Hangman骨折.中华医学杂志,2010,90(35):2451-2454.
15Muthukumar N.C1-C3 lateral mass fusion for typeⅡa and typeⅢHangman’s fracture.J Craniovertebr Junction Spine,2012,3(2):62-66.
16 Ma W,Xu R,Liu J,et al.Posterior short-segment fixation and fusion in unstable Hangman’s fractures.Spine(Phila Pa 1976),2011,36(7):529-533.
17Shin JJ,Kim SJ,Kim TH,et al.Optimal use of the halo-vest orthosis for upper cervical spine injuries.Yonsei Med J,2010,51(5):648-652.
18 Elmiligui Y,Koptan W,Emran I.Transpedicular screw fixation for typeⅡHangman’s fracture:a motion preserving procedure.Eur Spine J,2010,19(8):1299-1305.
19Wu YS,Lin Y,Zhang XL,et al.Management of Hangman’s fracture with percutaneous transpedicular screw fixation.Eur Spine J,2013,22(1):79-86.
20 Rayes M,Mittal M,Rengachary SS,et al.Hangman’s fracture:a historical and biomechanical perspective.J Neurosurg Spine,2011,2:198-208.
21张来仁,董宏袆,王世印.前路或后路手术治疗Hangman骨折的影响因素分析及临床疗效观察.中国矫形外科杂志,2015,23(4):313-317.
22 李金泉,徐皓,姚晓东,等.两种不同手术入路治疗不稳定Hangman骨折的比较.中国矫形外科杂志,2010,18(4):280-283.
23Abumi K,Shono Y,Ito M,et al.Complications of pedicle screw fixation in reconstructive surgery of the cervical spine.Spine,2000,8:962-969.