加自制横连的后路C_2椎弓根螺钉系统治疗不稳定Hangman骨折
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摘要
[目的]探讨加自制横连椎弓根螺钉治疗不稳定Hangman骨折的临床疗效。[方法]回顾性分析2011年2月~2015年4月在解放军101医院接受加自制横连联合C_2椎弓根螺钉系统手术治疗且病历资料完整的13例不稳定Hangman骨折患者的临床资料。记录手术时间、术中失血量,术后随访X线片和或CT观察骨折复位及愈合情况。[结果]手术时间(66.52±14.14)min,术中出血量(77.31±14.73)ml,术中无重要血管、神经损伤,术后无脑脊液漏、血肿形成及伤口感染等手术并发症。术后随访12~36个月,平均(22.32±8.51)个月,骨折部位于术后3个月复查时均正常骨性愈合,随访钉棒在位良好,无移位、滑脱现象。术前颈部疼痛VAS评分(6.84±1.23),末次随访时为(1.23±0.43),差异有统计学意义(P<0.05);[结论]加自制横连椎弓根螺钉治疗不稳定Hangman骨折,固定可靠,手术复位简单满意,并发症发生率低,临床疗效确切满意。
[Objective] To explore a novel cross-link configuration for combination with the posterior C_2 pedicle screw system in treatment of unstable Hangman.s fracture.[Method] A retrospective study was conducted on the clinical data of 13 patients who received posterior C_2 pedicle screws fixation combined with a novel "Ω" shaped cross-link for unstable Hangman fracture from February 2011 to April 2015 in the 101 st Hospital of PLA. The operation time, blood loss and the X-ray or CT checks of fracture reduction and healing were observed. [Results] All the 13 patients underwent successful operations lasted for(66.52±14.14) min on average, with blood loss of(77.31±14.73) ml, without severe complications, such as important neurovascular injuries, dural tear, hematoma formation and wound infection. The patients were followed up from 12 to 36 months with an average of(22.32±8.51) months. The fracture got bony healing at 3 months after the operation in all the patients. In addition, examination images in follow-up revealed that both the pedicle screws and cross link were kept in good condition without loosening, displacement and fracture in any patients. The neck pain VAS significantly decreased from(6.84±1.23) preoperatively to(1.23±0.43) at the latest follow-up(P<0.05).[Conclusion] The C_2 pedicle screws combined with this new-developed cross-link configuration for surgical treatment of unstable Hangman fracture with advantages of reliable fixation, simplified operative technique and reduced incidence of complication, do achieves satisfactory outcome.
[Objective] To explore a novel cross-link configuration for combination with the posterior C_2 pedicle screw system in treatment of unstable Hangman.s fracture.[Method] A retrospective study was conducted on the clinical data of 13 patients who received posterior C_2 pedicle screws fixation combined with a novel "Ω" shaped cross-link for unstable Hangman fracture from February 2011 to April 2015 in the 101 st Hospital of PLA. The operation time, blood loss and the X-ray or CT checks of fracture reduction and healing were observed. [Results] All the 13 patients underwent successful operations lasted for(66.52±14.14) min on average, with blood loss of(77.31±14.73) ml, without severe complications, such as important neurovascular injuries, dural tear, hematoma formation and wound infection. The patients were followed up from 12 to 36 months with an average of(22.32±8.51) months. The fracture got bony healing at 3 months after the operation in all the patients. In addition, examination images in follow-up revealed that both the pedicle screws and cross link were kept in good condition without loosening, displacement and fracture in any patients. The neck pain VAS significantly decreased from(6.84±1.23) preoperatively to(1.23±0.43) at the latest follow-up(P<0.05).[Conclusion] The C_2 pedicle screws combined with this new-developed cross-link configuration for surgical treatment of unstable Hangman fracture with advantages of reliable fixation, simplified operative technique and reduced incidence of complication, do achieves satisfactory outcome.
引文
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[5]刘德宝,张复文,卜海富,等.椎弓根拉力螺钉内固定治疗Hangman骨折[J].临床骨科杂志,2012,15(4):361-363.
[6]梁裕,龚耀成,郑涛,等.第2、3颈椎后路钢板螺钉内固定治疗Hangman骨折[J].中国脊柱脊髓杂志,2004,14(1):36-38.
[7]张宝成,蔡贤华,丁然,等.Hangman骨折诊断和治疗进展[J].中国修复重建外科杂志,2015,29(4):513-517.
[8]Hur H,Lee J K,Jang J W,et al.Is it feasible to treat unstable Hangman's fracture via the primary standard anterior retropharyngeal approach[J].Eur Spine J,2014,23(8):1641-1647.
[9]陈语.Hangman骨折的生物力学及临床研究[D].第二军医大学,2004.
[10]康辉,贾连顺,谭军,等.椎弓根螺钉固定或联合侧块螺钉固定治疗Hangman骨折[J].中国脊柱脊髓杂志,2007,17(10):757-760.
[2]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[J].中国矫形外科杂志,2010,18(4):280-283.
[3]Ge C,Hao D,He B,et al.Anterior cervical discectomy and fusion versus posterior fixation and fusion of C2-3for unstable hangman's fracture[J].J Spinal Disord Tech,2015,28(2):E61-E66.
[4]王松,杨函,王高举,等.带拉力螺钉的后路钉棒系统治疗不稳定Hangman骨折的临床应用[J].中国矫形外科杂志,2015,23(24):2219-2224.
[5]刘德宝,张复文,卜海富,等.椎弓根拉力螺钉内固定治疗Hangman骨折[J].临床骨科杂志,2012,15(4):361-363.
[6]梁裕,龚耀成,郑涛,等.第2、3颈椎后路钢板螺钉内固定治疗Hangman骨折[J].中国脊柱脊髓杂志,2004,14(1):36-38.
[7]张宝成,蔡贤华,丁然,等.Hangman骨折诊断和治疗进展[J].中国修复重建外科杂志,2015,29(4):513-517.
[8]Hur H,Lee J K,Jang J W,et al.Is it feasible to treat unstable Hangman's fracture via the primary standard anterior retropharyngeal approach[J].Eur Spine J,2014,23(8):1641-1647.
[9]陈语.Hangman骨折的生物力学及临床研究[D].第二军医大学,2004.
[10]康辉,贾连顺,谭军,等.椎弓根螺钉固定或联合侧块螺钉固定治疗Hangman骨折[J].中国脊柱脊髓杂志,2007,17(10):757-760.