Li Zhonghai, Li Fengning, Hou Shuxun, Zhao Yantao, Mao Ningfang, Hou Tiesheng, Tang Jiaguang
Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, Beijing; and.
J Neurosurg Spine. 2015 Apr;22(4):387-93. doi: 10.3171/2014.11.SPINE13959. Epub 2015 Jan 30.
The object of this study was to describe the authors' method of anterior discectomy/corpectomy and fusion combined with internal fixation for the treatment of unstable hangman's fractures and to evaluate the clinical and radiological outcomes.
This study included 38 consecutive patients who underwent surgery for unstable hangman's fractures between July 2002 and October 2011 and were followed up for more than 2 years. The patients were 18 women and 20 men with a mean age of 42.8 years (range 20-69 years). The fracture resulted from a fall in 9 patients, a motor vehicle accident in 21 patients, and a motorcycle accident in 8 patients. The Levine-Edwards classification was Type II in 13 patients, Type IIA in 20 patients, and Type III in 5 patients. All patients underwent anterior C2-3 intervertebral disc excision or C-3 corpectomy, decompression and reduction, interbody implantation of an autologous iliac bone graft, and internal fixation with a titanium plate. Pain was assessed before and after surgery using a visual analog scale (VAS). Myelopathy was graded using the Japanese Orthopaedic Association (JOA) score. Patient satisfaction with the surgery was assessed using Odom's grading system. Anteroposterior, lateral, and dynamic (flexion/extension) radiographs were obtained during the follow-up period. Two-dimensional CT studies with sagittal and coronal reconstructions were routinely performed.
The mean follow-up period was 49.2 months (range 24-132 months). There was a significant decrease between the preoperative and final follow-up VAS scores (mean [SD] 7.56 ± 1.52 vs 2.36 ± 1.25, p < 0.05) and a significant increase between the preoperative and final follow-up JOA scores (12.58 ± 1.34 vs 16.13 ± 1.17, p < 0.05). Postoperative radiographs showed satisfactory reduction of the fracture in all cases. Postoperative complications included transient neurological deficits (3 cases), hematoma (2 cases), temporary dysphagia (5 cases), temporary hoarseness (2 cases), prolonged pain at the iliac crest donor site (4 cases), and wound infection at the iliac crest donor site (2 cases). Solid fusion was achieved in 94.7% of patients at the final follow-up.
Anterior discectomy/corpectomy and fusion combined with internal fixation is a safe and effective procedure for the treatment of unstable hangman's fractures.
本研究的目的是描述作者采用前路椎间盘切除术/椎体次全切除术及融合联合内固定治疗不稳定型绞刑架骨折的方法，并评估临床和影像学结果。
本研究纳入了2002年7月至2011年10月期间连续接受手术治疗不稳定型绞刑架骨折且随访时间超过2年的38例患者。患者中女性18例，男性20例，平均年龄42.8岁（范围20 - 69岁）。骨折原因包括9例跌倒、21例机动车事故和8例摩托车事故。Levine-Edwards分型中，II型13例，IIA型20例，III型5例。所有患者均接受了前路C2 - 3椎间盘切除术或C3椎体次全切除术、减压复位、自体髂骨植骨椎间融合及钛板内固定。术前和术后采用视觉模拟评分法（VAS）评估疼痛。采用日本骨科学会（JOA）评分对脊髓病进行分级。采用Odom分级系统评估患者对手术的满意度。随访期间拍摄正位、侧位及动态（屈伸位）X线片。常规进行矢状面和冠状面重建的二维CT检查。
平均随访时间为49.2个月（范围24 - 132个月）。术前与末次随访时的VAS评分有显著下降（平均[标准差]7.56±1.52对2.36±1.25，p < 0.05），术前与末次随访时的JOA评分有显著提高（12.58±1.34对16.13±1.17，p < 0.05）。术后X线片显示所有病例骨折复位满意。术后并发症包括短暂性神经功能缺损（3例）、血肿（2例）、暂时性吞咽困难（5例）、暂时性声音嘶哑（2例）、髂嵴供骨部位长期疼痛（4例）及髂嵴供骨部位伤口感染（2例）。末次随访时94.7%的患者实现了牢固融合。
前路椎间盘切除术/椎体次全切除术及融合联合内固定是治疗不稳定型绞刑架骨折的一种安全有效的方法。
