后路钉棒固定非融合治疗新鲜II型和IIA型Hangman骨折
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南部战区总医院

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广州市民生科技攻关计划项目(编号:201803010046)


The primary clinical result of applying a posterior nonfusion screw-rod fixation method for fresh type II and IIA Hangman fractures
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General Hospital of Guangzhou Military Region

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    摘要:

    [目的] 介绍颈椎后路钉棒固定非融合治疗新鲜II型和IIA型Hangman骨折的临床初步疗效。[方法] 自2010年6月至2017年6月,筛选10例II型和IIA型的新鲜Hangman骨折患者,其中II型6例,IIA型4例;车祸伤8例,坠落伤2例;伤后5小时~9天入院,平均4天;其中男7例,女3例;年龄28~62岁,平均41岁。在气管插管全麻下施行了一期后路C1~C3钉棒固定,而不进行后路植骨;待术后随访CT复查显示椎弓骨折骨性愈合后,二期后路手术取出内固定,并观察颈椎运动功能的恢复情况。[结果] 所有10例患者均成功进行后路钉棒固定,术中椎弓骨折复位满意,未发生椎动脉、脊髓损伤。患者一期术后随访6~12个月,CT复查显示10例患者Hangman骨折均获得骨性愈合。二期后路钉棒内固定取出术后6~12个月内颈椎运动功能基本恢复正常。[结论] 对于新鲜II型和IIA型Hangman骨折,一期后路钉棒固定二期取出内固定的方法不仅可获得满意的骨折复位,而且不残留内植物同时还可保留颈椎节段间的运动功能,是前路和后路固定融合术的有益补充。

    Abstract:

    [Objective] To introduce the primary clinical result of applying a posterior nonfusion screw-rod fixation method for fresh type II and IIA Hangman fractures. [Method] From June 2010 to June 2017, selected 10 patients with type II or IIA of fresh Hangman fracture, including 6 cases with type II fracture and 4 cases with type IIA fracture, suffered from traffic accidents in 8 cases and falling accidents in 2 cases,admitted to hospital after average 4 days (ranging from 5h to 9d). 7 males and 3 females, aged from 28 to 62 years old, averaged 41 years old. Under the general anesthesia, all the 10 cases treated with C1-C3 screw-rods fixation but no bone grafting. When a solid bone union of the Hangman fracture was confirmed by CT scan, a second stage operation of the instruments removing was performed, and the recovery of cervical movement function was observed. [Result] All 10 cases got the Hangman fracture reduction and a successful posterior C1-C3 screw-rods fixation, and no neural or vascular injury was observed. The cases were followed up from 6 to 12 months after the first stage operation, and all the patients had a solid bone union on CT scans. After instruments remove out, the cervical spine movement function almost restored to normal in all cases within a 6 to 12 months follow up. [Conclusion] For fresh type II and IIA Hangman fracture, applying a first stage posterior screw-rods fixation and a second stage instruments removing treatment method can not only reset the fracture satisfactorily, but also reserve movement function of the cervical spine with no residuary instruments, which is a compensatory method for anterior or posterior fixation and fusion techniques.

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  • 收稿日期:2019-08-25
  • 最后修改日期:2019-08-25
  • 录用日期:2019-09-12
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