颈前路钢板内固定治疗Ⅱ型和ⅡA型Hangman骨折的疗效分析
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摘要
目的临床上对于Ⅱ型和ⅡA型Hangman骨折的手术入路选择仍有争议。文中旨在评价颈前路钢板内固定治疗Ⅱ型和ⅡA型Hangman骨折的临床疗效。方法回顾性分析2014年1月至2017年8月东部战区总医院骨科收治的17例Ⅱ型和ⅡA型Hangman骨折患者。所有患者均采用颈前路钢板内固定术治疗,统计分析手术时间,术中出血量,术后引流量等,术前、术后3个月、术后1年采用视觉模拟评分(VAS)评估颈肩部疼痛,颈椎功能障碍指数量表(NDI)评估颈椎功能,以及评估放射学指标(C2/3局部后凸角、C2椎体前移距离)及植骨融合情况。结果手术时间平均为95.6(80～116)min,术中出血量平均为32.6(25～50)mL,术后引流量平均为35.6(25～50)mL,平均住院时间为6.2(5～8)d。所有患者均未出现脑脊液漏、神经症状加重、切口感染、内固定失败等并发症。术后3个月C2/3局部后凸角[(-2.12±3.20)°]、C2椎体前移距离[(1.02±0.63)mm]与术前[(12.24±2.17)°、(3.47±1.46)mm]比较差异有统计学意义(P<0.05);VAS、NDI与术前比较差异亦有统计学意义(P<0.05)。术后1年VAS、NDI[(1.23±0.44)、(4.82±2.81)分]较术后3个月[(1.65±0.49)、(13.47±2.70)分]降低(P<0.05)。结论对于Ⅱ型和ⅡA型Hangman骨折患者,采用颈前路钢板内固定术可有效恢复颈椎生理曲度,重建颈椎稳定性,且具有创伤小、并发症少、恢复快等优势。
Objective There are still disputes about the clinical treatment of type Ⅱ and type ⅡA Hangman′s fracture.The article aimed to explore the clinical efficacy of anterior cervical plate fixation for type Ⅱ and type ⅡA Hangman′s fracture.Methods Seventeen patients with type Ⅱ and type ⅡA Hangman′s fracture combined with intervertebral disc injury were analyzed in our department from January 2013 to August 2017,including 12 males and 5 females,aged from 27 to 76 years old,with an aver?age age of 54.9 years. The operative time and intraoperative blood loss and postoperative drainage were recorded. The effectiveness was evaluated using visual analogue scale(VAS)for occipitocervical pain,and the Neck Disability Index(NDI)score for cervical vertebra function. Radiological indices(C2/3 local kyphotic angle,C2 translation)and bone graft fusion were evaluated by Xray.Results All the patients were followed up successfully. No ce?rebrospinal fluid leakage occurred during the operation. There were no broken nails,broken slab,and loose internal fixation. All the pa?tients were almost free from occipitocervical pain and neurological function of all patients improved partially. The VAS and NDI scores were significantly improved at 3 months after operation and one year when compared with preoperative scores(P<0.05). The C2/3 local kyphotic angle was corrected significantly with the mean preopera?tive 12.24±2.17 degrees,initial postoperative-2.12±3.20 degrees and the latest follow-up-1.88±2.67 degrees respectively(P<0.05).The C2 translation was also corrected significantly with the mean preoperative 3.47±1.46 mm,initial postoperative 1.02±0.63 mm,and the latest follow-up 1.21±0.56 mm respectively(P<0.05). All the patients had good bone graft fusion.Conclusion For type Ⅱand type ⅡA Hangman′s fracture,the method of anterior cervical plate fixation can effectively restore cervical curvature and recon?struct cervical stability,which is featured by the advantage of less trauma,fewer complications and faster recovery.
Objective There are still disputes about the clinical treatment of type Ⅱ and type ⅡA Hangman′s fracture.The article aimed to explore the clinical efficacy of anterior cervical plate fixation for type Ⅱ and type ⅡA Hangman′s fracture.Methods Seventeen patients with type Ⅱ and type ⅡA Hangman′s fracture combined with intervertebral disc injury were analyzed in our department from January 2013 to August 2017,including 12 males and 5 females,aged from 27 to 76 years old,with an aver?age age of 54.9 years. The operative time and intraoperative blood loss and postoperative drainage were recorded. The effectiveness was evaluated using visual analogue scale(VAS)for occipitocervical pain,and the Neck Disability Index(NDI)score for cervical vertebra function. Radiological indices(C2/3 local kyphotic angle,C2 translation)and bone graft fusion were evaluated by Xray.Results All the patients were followed up successfully. No ce?rebrospinal fluid leakage occurred during the operation. There were no broken nails,broken slab,and loose internal fixation. All the pa?tients were almost free from occipitocervical pain and neurological function of all patients improved partially. The VAS and NDI scores were significantly improved at 3 months after operation and one year when compared with preoperative scores(P<0.05). The C2/3 local kyphotic angle was corrected significantly with the mean preopera?tive 12.24±2.17 degrees,initial postoperative-2.12±3.20 degrees and the latest follow-up-1.88±2.67 degrees respectively(P<0.05).The C2 translation was also corrected significantly with the mean preoperative 3.47±1.46 mm,initial postoperative 1.02±0.63 mm,and the latest follow-up 1.21±0.56 mm respectively(P<0.05). All the patients had good bone graft fusion.Conclusion For type Ⅱand type ⅡA Hangman′s fracture,the method of anterior cervical plate fixation can effectively restore cervical curvature and recon?struct cervical stability,which is featured by the advantage of less trauma,fewer complications and faster recovery.
引文
[1]Cho DY,Liau WR,Lee WY,et al.Preliminary experience using a polyetheretherketone(PEEK)cage in the treatment of cervical disc disease[J].Neurosurgery,2002,51(6):1343-1349;discussion 1349-1350.
[2]Levine AM,Edwards CC.The management of traumatic spondylolisthesis of the axis[J].J Bone Joint Surg Am,1985,67(2):217-226.
[3]Wei F,Wang L,Zhou Z,et al.Cervical cage without plating in management of type II/II A Hangman′s fracture combined with intervertebral disc injury[J].BMC Musculoskelet Disord,2015,16:285.
[4]Ge C,Hao D,He B,et al.Anterior cervical discectomy and fusion versus posterior fixation and fusion of C2-3 for unstable hangman′s fracture[J].J Spinal Disord Tech,2015,28(2):E61-66.
[5]Leferink VJ,Zimmerman KW,Veldhuis,et al.Thoracolumbar spinal fractures:radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients[J].Eur Spine J,2001,10(6):517-523.
[6]Wei F,Pan X,Zhou Z,et al.Anterior-only stabilization using cage versus plating with bone autograft for the treatment of type II/IIA Hangman′s fracture combined with intervertebral disc injury[J].J Orthop Surg Res,2015,10:33.
[7]陈雄生,贾连顺,曹师锋,等,Hangman骨折伴椎间盘损伤的诊断与外科治疗[J].中华外科杂志,2004,42(12):712-715.
[8]田发明,李舒扬,骆阳,等,辛伐他汀对去势大鼠椎体骨量及椎间盘退变的作用[J].医学研究生学报,2017,30(2):127-131.
[9]Murphy H,Schroeder GD,Shi WJ,et al.Management of Hangman′s Fractures:A Systematic Review[J].J Orthop Trauma,2017,31(Suppl4):S90-S95.
[10]王宾宾,杨进城,杨浩志,等,后路寰枢椎内固定技术的研究进展[J].医学研究生学报,2018,31(10):1115-1120.
[11]Li Z,Li F,Hou S,et al.Anterior discectomy/corpectomy and fusion with internal fixation for the treatment of unstable hangman′s fractures:a retrospective study of 38 cases[J].J Neurosurg Spine,2015,22(4):387-393.
[12]Zhang B,Cai X,Ding R,et al.Research progress of diagnosis and treatment of Hangman fracture[J].Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi,2015,29(4):513-517.
[13]Zhang Y,Zhang J,Wang X,et al.Application of the cervical subaxial anterior approach at C2 in select patients[J].Orthopedics,2013,36(5):e554-560.
[14]Watanabe M,Nomura T,Toh E,et al.Residual neck pain after traumatic spondylolisthesis of the axis[J].J Spinal Disord Tech,2005,18(2):148-151.
[15]Abumi K,Shono Y,Ito M,et al.Complications of pedicle screw fixation in reconstructive surgery of the cervical spine[J].Spine(Phila Pa1976),2000,25(8):962-969.
[2]Levine AM,Edwards CC.The management of traumatic spondylolisthesis of the axis[J].J Bone Joint Surg Am,1985,67(2):217-226.
[3]Wei F,Wang L,Zhou Z,et al.Cervical cage without plating in management of type II/II A Hangman′s fracture combined with intervertebral disc injury[J].BMC Musculoskelet Disord,2015,16:285.
[4]Ge C,Hao D,He B,et al.Anterior cervical discectomy and fusion versus posterior fixation and fusion of C2-3 for unstable hangman′s fracture[J].J Spinal Disord Tech,2015,28(2):E61-66.
[5]Leferink VJ,Zimmerman KW,Veldhuis,et al.Thoracolumbar spinal fractures:radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients[J].Eur Spine J,2001,10(6):517-523.
[6]Wei F,Pan X,Zhou Z,et al.Anterior-only stabilization using cage versus plating with bone autograft for the treatment of type II/IIA Hangman′s fracture combined with intervertebral disc injury[J].J Orthop Surg Res,2015,10:33.
[7]陈雄生,贾连顺,曹师锋,等,Hangman骨折伴椎间盘损伤的诊断与外科治疗[J].中华外科杂志,2004,42(12):712-715.
[8]田发明,李舒扬,骆阳,等,辛伐他汀对去势大鼠椎体骨量及椎间盘退变的作用[J].医学研究生学报,2017,30(2):127-131.
[9]Murphy H,Schroeder GD,Shi WJ,et al.Management of Hangman′s Fractures:A Systematic Review[J].J Orthop Trauma,2017,31(Suppl4):S90-S95.
[10]王宾宾,杨进城,杨浩志,等,后路寰枢椎内固定技术的研究进展[J].医学研究生学报,2018,31(10):1115-1120.
[11]Li Z,Li F,Hou S,et al.Anterior discectomy/corpectomy and fusion with internal fixation for the treatment of unstable hangman′s fractures:a retrospective study of 38 cases[J].J Neurosurg Spine,2015,22(4):387-393.
[12]Zhang B,Cai X,Ding R,et al.Research progress of diagnosis and treatment of Hangman fracture[J].Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi,2015,29(4):513-517.
[13]Zhang Y,Zhang J,Wang X,et al.Application of the cervical subaxial anterior approach at C2 in select patients[J].Orthopedics,2013,36(5):e554-560.
[14]Watanabe M,Nomura T,Toh E,et al.Residual neck pain after traumatic spondylolisthesis of the axis[J].J Spinal Disord Tech,2005,18(2):148-151.
[15]Abumi K,Shono Y,Ito M,et al.Complications of pedicle screw fixation in reconstructive surgery of the cervical spine[J].Spine(Phila Pa1976),2000,25(8):962-969.