Li Guangzhou, Wang Qing, Liu Hao
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.
Medicine (Baltimore). 2017 May;96(19):e6847. doi: 10.1097/MD.0000000000006847.
The aim of this study was to evaluate the anatomical variations and injuries in patients with unstable Hangman fractures that affected the posterior pedicle screw placement of C2 to C3 and retrospectively review our experience with management of these fractures. Clinical data were reviewed in 72 patients with unstable Hangman fractures, especially using 3-dimensional computed tomography (3D-CT) scan to identify the presence of anatomical variations or injuries and analyzing the treatment strategies we used. Twenty-two patients (22/72, 30.6%) with 39 (C2 or C3) risk factors were not fit for safe C2 to C3 pedicle screw placement, due to factors such as small pedicle size of C2 or C3, high-riding vertebral arteries, fractured fragments encased into vertebral canal, or transverse process foramen of C2, sclerotic pedicles and pedicle fractures of C3. One or more than one of these risk factors could pose more risks of arterial or neural structures damages to pedicle screw fixation for unstable Hangman fractures. Individualized treatment plans were made to minimize the risks of surgery for the 22 patients. There is a high incidence of anatomical variations and injuries in the C2 to C3 region in patients with unstable Hangman fractures that affect the pedicle screw placement. Preoperative evaluation of these conditions using 3D-CT scans is of paramount importance to avoid and decrease operative complications and to choose appropriate surgical techniques.
本研究的目的是评估不稳定型绞刑者骨折患者中影响C2至C3椎弓根螺钉置入的解剖变异和损伤情况，并回顾性分析我们对这些骨折的治疗经验。对72例不稳定型绞刑者骨折患者的临床资料进行了回顾，尤其利用三维计算机断层扫描（3D-CT）来识别解剖变异或损伤的存在，并分析我们所采用的治疗策略。22例患者（22/72，30.6%）存在39个（C2或C3）危险因素，因C2或C3椎弓根细小、椎动脉高位走行、骨折碎片突入椎管、C2横突孔、C3椎弓根硬化及椎弓根骨折等因素，不适合安全地进行C2至C3椎弓根螺钉置入。这些危险因素中的一个或多个可能会给不稳定型绞刑者骨折的椎弓根螺钉固定带来更多的动脉或神经结构损伤风险。针对这22例患者制定了个体化治疗方案，以尽量降低手术风险。不稳定型绞刑者骨折患者中影响椎弓根螺钉置入的C2至C3区域解剖变异和损伤的发生率较高。术前使用3D-CT扫描评估这些情况对于避免和减少手术并发症以及选择合适的手术技术至关重要。
