中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
35期
2451-2454
,共4页
马毅%邓树才%刘建坤%郝永宏%李建江%吕工一
馬毅%鄧樹纔%劉建坤%郝永宏%李建江%呂工一
마의%산수재%류건곤%학영굉%리건강%려공일
骨折%椎间盘切除术%固定%脊柱融合术
骨摺%椎間盤切除術%固定%脊柱融閤術
골절%추간반절제술%고정%척주융합술
Fracture%Anterior approach%Discectomy%Spinal fusion
目的 探讨经前路间盘切除植骨融合治疗Hangman骨折的治疗结果和治疗特点.方法 对天津医院脊柱外科2005年6月至2008年12月诊治的36例Hangman骨折患者进行回顾性分析.所有患者均行X线片、CT和MRI检查.其中手术治疗27例患者,按照Levine-Edwards分型标准:Ⅱ型17例,Ⅱa型10例.在全麻下行常规颈前方入路显露C2-3椎体,切除C2-3椎间盘组织,充分减压,取自体髂骨植骨及钢板固定.术后颈托保护4周,对手术时间、住院时间、并发症、合并症、神经恢复情况及融合率做评估.结果 27例手术患者均获随访,平均随访15(10~36)个月.无一例出现椎体再移位和成角畸形.术前疼痛均获得缓解,术前神经功能障碍获得改善.未发现脊髓损伤、椎动脉损伤、脑脊液漏等并发症,没有发生与内植物相关的并发症,手术时间和住院时间与下颈椎手术时间相似,所有患者6个月内完全融合.结论 经常规颈前路C2-3间盘摘除植骨融合钢板内固定治疗Hangman骨折疗效确切,安全可行.
目的 探討經前路間盤切除植骨融閤治療Hangman骨摺的治療結果和治療特點.方法 對天津醫院脊柱外科2005年6月至2008年12月診治的36例Hangman骨摺患者進行迴顧性分析.所有患者均行X線片、CT和MRI檢查.其中手術治療27例患者,按照Levine-Edwards分型標準:Ⅱ型17例,Ⅱa型10例.在全痳下行常規頸前方入路顯露C2-3椎體,切除C2-3椎間盤組織,充分減壓,取自體髂骨植骨及鋼闆固定.術後頸託保護4週,對手術時間、住院時間、併髮癥、閤併癥、神經恢複情況及融閤率做評估.結果 27例手術患者均穫隨訪,平均隨訪15(10~36)箇月.無一例齣現椎體再移位和成角畸形.術前疼痛均穫得緩解,術前神經功能障礙穫得改善.未髮現脊髓損傷、椎動脈損傷、腦脊液漏等併髮癥,沒有髮生與內植物相關的併髮癥,手術時間和住院時間與下頸椎手術時間相似,所有患者6箇月內完全融閤.結論 經常規頸前路C2-3間盤摘除植骨融閤鋼闆內固定治療Hangman骨摺療效確切,安全可行.
목적 탐토경전로간반절제식골융합치료Hangman골절적치료결과화치료특점.방법 대천진의원척주외과2005년6월지2008년12월진치적36례Hangman골절환자진행회고성분석.소유환자균행X선편、CT화MRI검사.기중수술치료27례환자,안조Levine-Edwards분형표준:Ⅱ형17례,Ⅱa형10례.재전마하행상규경전방입로현로C2-3추체,절제C2-3추간반조직,충분감압,취자체가골식골급강판고정.술후경탁보호4주,대수술시간、주원시간、병발증、합병증、신경회복정황급융합솔주평고.결과 27례수술환자균획수방,평균수방15(10~36)개월.무일례출현추체재이위화성각기형.술전동통균획득완해,술전신경공능장애획득개선.미발현척수손상、추동맥손상、뇌척액루등병발증,몰유발생여내식물상관적병발증,수술시간화주원시간여하경추수술시간상사,소유환자6개월내완전융합.결론 경상규경전로C2-3간반적제식골융합강판내고정치료Hangman골절료효학절,안전가행.
Objective To evaluate the efficacies and features of treating Hangman's fracture by anterior cervical discectomy and fusion (ACDF). Methods Since June 2005 to December 2008, 36 cases with Hangman's fracture were analyzed with their clinical data including history, symptoms, signs,radiological findings and treatments. According to the classification system designed by Levine and Edwards depending on the radiological manifestations of Hangman's fractures, they were subdivided into type Ⅰ ( n =9) (conservative therapy), type Ⅱ (n = 17) and type ⅡA (n = 10). Conservative therapy was offered to type Ⅰ in 9 cases, while ACDF with cervical gear protection for 4 weeks after surgery was performed to type Ⅱ in 17 cases and type Ⅱ A in 10 cases. A combination of operation time, days of hospitalization,complications, neurological improvement and fusion rate was assessed. Results An average follow-up of 15months (range: 10 -36) was achieved. No vertebral redisplacement and angulation deformity occurred.Axial pain was relieved in each case. The preoperative neurological deficits in all patients got improvements. No spinal cord injury, vertebral artery injury or cerebrospinal fluid leakage ocurred. No complication related to internal fixator was found. Average operative time and hospitalization were similar to those of ACDF for lower cervical spine(98 minutes vs. 9 days). Fusion was achieved within 6 months in all cases. Conclusion ACDF at C2-C3 may be an effective and safe way to treat Hangman's fracture.