Wei Fuxin, Pan Ximin, Zhou Zhiyu, Cui Shangbin, Zhong Rui, Wang Le, Gao Manman, Chen Ningning, Liang Zijian, Zou Xuenong, Huang Sheng, Liu Shaoyu
Department of Spine Surgery, The First Affiliated Hospital and Orthopedic Research Institute of Sun Yat-sen University, Guangzhou, China.
Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
J Orthop Surg Res. 2015 Mar 11;10:33. doi: 10.1186/s13018-015-0164-1.
Anterior C2/3 discectomy and interbody fusion (ACDF) with plating is increasingly performed as the primary treatment of unstable Hangman's fracture; however, plate-related complications, such as screw back-out, plate fracture and soft-tissue injury, is not uncommon. Polyetheretherketone (PEEK) cage has now been developed to provide initial stability before fusion; however, whether and how ACDF with PEEK cage offer better clinical results compared with ACDF with plating in management of Hangman's fracture remains unknown. This study compares the efficacy of ACDF with plating to that of ACDF with PEEK cage in management of type II/IIA Hangman's fractures (according to Levine and Edwards classification) retrospectively.
From February 2006 to March 2012, a total of 21 patients with type II/IIA Hangman's fractures combined with intervertebral disc injury underwent ACDF with PEEK cage, and 28 patients underwent ACDF with plating. Perioperative parameters were compared. The average follow-up period was 50.3 months (range 27-76 months). The clinical outcome (visual analog scale (VAS), American Spinal Injury Association (ASIA) scale, and clinical post-traumatic neck score (PTNC)) and radiological outcome (translation of C2, local kyphotic angle (LKA), and fusion status of C2/3) was compared retrospectively.
The operative time and blood loss were significantly less in the ACDF with cage group compared with that in the ACDF with plating group (P < 0.05). All patients showed neurological recovery and achieved solid fusion. There were no significant differences in the clinical and radiological outcomes at final follow-up between groups, except in the LKA and the correction loss rate of LKA which were higher in the ACDF with plating group (P < 0.05). Donor-site pain occurred in two patients (10.1%) within 6 months after operation in the ACDF with plating group and none in the ACDF with cage group. All patients recovered without any adverse effects.
ACDF with PEEK cage is effective and reliable in management of type II/IIA Hangman's fractures and is more cost-effective due to shorter operative time and less blood loss requirements.
前路C2/3椎间盘切除椎间融合术（ACDF）联合钢板内固定作为不稳定型Hangman骨折的主要治疗方法应用越来越广泛；然而，钢板相关并发症，如螺钉松动、钢板断裂及软组织损伤并不少见。聚醚醚酮（PEEK）椎间融合器现已研发出来，可在融合前提供初始稳定性；然而，在Hangman骨折的治疗中，与ACDF联合钢板内固定相比，使用PEEK椎间融合器的ACDF是否能提供更好的临床效果以及如何提供更好的临床效果仍不清楚。本研究回顾性比较了ACDF联合钢板内固定与ACDF联合PEEK椎间融合器治疗II型/IIA型Hangman骨折（根据Levine和Edwards分类）的疗效。
2006年2月至2012年3月，共有21例II型/IIA型Hangman骨折合并椎间盘损伤患者接受了ACDF联合PEEK椎间融合器治疗，28例患者接受了ACDF联合钢板内固定治疗。比较围手术期参数。平均随访时间为50.3个月（范围27 - 76个月）。回顾性比较临床疗效（视觉模拟评分（VAS）、美国脊髓损伤协会（ASIA）评分及创伤后颈部临床评分（PTNC））和影像学疗效（C2移位、局部后凸角（LKA）及C2/3融合情况）。
与ACDF联合钢板内固定组相比，ACDF联合椎间融合器组的手术时间和失血量明显更少（P < 0.05）。所有患者神经功能均有恢复且均实现了牢固融合。末次随访时，两组间临床和影像学疗效无显著差异，但ACDF联合钢板内固定组的LKA及LKA矫正丢失率更高（P < 0.05）。ACDF联合钢板内固定组有2例患者（10.1%）在术后6个月内出现供区疼痛，而ACDF联合椎间融合器组无此情况。所有患者均康复，无任何不良反应。
ACDF联合PEEK椎间融合器治疗II型/IIA型Hangman骨折有效且可靠，且由于手术时间更短、失血量更少，更具成本效益。
