【摘要】 目的探讨伴椎间组织损伤(椎间盘、前后纵韧带及项韧带)Hangman骨折的治疗策略及临床意义。方法自2004年10月~2009年10月对收治的20例均存在不同程度的椎间组织损伤Hangman骨折行前路前、中柱重建术,其中16例行椎间融合锁定钢板内固定术;4例行C3椎体次全切C2～4椎间融合锁定钢板内固定术;术后进行12～48个月,平均(25+2)个月随访。结果术后症状明显恢复。全部患者颈椎生理前凸及解剖序列得到完全恢复,C2骨折愈合良好,术后6个月植骨融合率100%,无内固定系统松动、断裂及椎间高度丢失等现象,颈椎活动与正常同龄人比较(P>0.05),无统计学意义。结论伴椎间组织损伤Hangman骨折的治疗需要处理损伤的椎间盘,以重建C2、3的稳定性;应用颈椎前路锁定钢板内固定治疗具有可获得术后上颈椎即刻稳定,达到颈椎生理所需的C2、3椎间稳定固定,且术后不影响颈椎的活动功能,是治疗椎间组织损伤Hangman骨折的理想方法。更多还原

【Abstract】 Objective To explore the management strategies and clinical signification of Hangman’s fracture with intervertebral tissue(including: intervertebral disc,anterior longitudinal ligament,posterior longitudinal ligament and nuchal ligament) injury.Methods Twenty patients with Hangman’s fracture all were treated by anterior column reconstruction and locking plate fixation between October 2004 and October 2009(All patients had varying degrees of intervertebral tissue injured): 4 routines by C3 anterior subtotal cutting and C2～4 fusion and fixing with locking plate fixation;16 cases of anterior interbody reconstruction and fusion and fixing with locking plate fixation.All patients were followed up for 12 to 48 months(mean 25+2 months).Results Clinical symptoms were relieved in all cases after operation.A stable bony fusion was achieved in all cases postoperatively.There was not only no broken or loosening,but also no interbody height loss.Compared with normal peers,cervical spine was no significant difference in functions.(P >0.05) Conclusion Hangman’s fracture with intervertebral tissue injury need a treatment of the injured disc to rebuild the stability of C2、3.For patient with Hangman’s fracture with intervertebral tissue injured,anterior fusion and internal fixation under column reconstruction can offers an immediate stability and a high rate of successful bony fusion,which can avoid late C2、3 intervertebral degeneration from occurring intervertebral instability by posterior surgery.In the respect of renewing cervical lordosis and anatomical sequence,it has more significant advantages,which can obtain and maintain a satisfactory reduction.So the surgical management of anterior column reconstruction is a perfect method to treat the Hangman’s fractures with intervertebral tissue injury.更多还原