CAJ | 학술논문

背景：Hangman骨折即创伤性枢椎滑脱，不稳定Hangman骨折的Ⅱ型、Ⅱa型及ⅡI 型骨折需要手术治疗。咽后入路是上颈椎前路手术显露的常用手段。然而，重要结构周围的牵拉与分离使得手术程序复杂，增加了神经损伤的发生率。 　　目的：评价创新性应用多聚醚酮椎间融合器治疗Hangman骨折的临床疗效及安全性。 　　方法：收集Ⅱ型及Ⅱa型Hangman骨折患者8例，均进行C2/3椎间融合。术后随访进行X射线检查，评价融合时间及内植物位置。比较术前与术后6个月骨折处成角及移位数据和复位情况，以颈椎创伤后评分评价功能恢复，以目测类比评分评价颈部疼痛。 　　结果与结论：所有8例患者均得以成功随访，平均随访13个月(6-26个月)。与术前相比，术后6个月患者颈椎创伤后评分增高，目测类比评分及成角畸形和移位均降低(P<0.05)。全部患者末次随访未见颈部活动受限，术后3或6个月所有患者椎间均骨性融合，无相关并发症。结果证实，应用多聚醚酮椎间融合器治疗Ⅱ型及Ⅱa型Hangman骨折临床疗效及安全性均较好。
배경：Hangman골절즉창상성추추활탈，불은정Hangman골절적Ⅱ형、Ⅱa형급ⅡI 형골절수요수술치료。인후입로시상경추전로수술현로적상용수단。연이，중요결구주위적견랍여분리사득수술정서복잡，증가료신경손상적발생솔。 　　목적：평개창신성응용다취미동추간융합기치료Hangman골절적림상료효급안전성。 　　방법：수집Ⅱ형급Ⅱa형Hangman골절환자8례，균진행C2/3추간융합。술후수방진행X사선검사，평개융합시간급내식물위치。비교술전여술후6개월골절처성각급이위수거화복위정황，이경추창상후평분평개공능회복，이목측류비평분평개경부동통。 　　결과여결론：소유8례환자균득이성공수방，평균수방13개월(6-26개월)。여술전상비，술후6개월환자경추창상후평분증고，목측류비평분급성각기형화이위균강저(P<0.05)。전부환자말차수방미견경부활동수한，술후3혹6개월소유환자추간균골성융합，무상관병발증。결과증실，응용다취미동추간융합기치료Ⅱ형급Ⅱa형Hangman골절림상료효급안전성균교호。
BACKGROUND: Unstable cases of Hangman’s fracture or traumatic spondylilisthesis which are type II, IIa and III should be treated surgicaly. Retropharyngeal approach was employed in exposure of anterior upper cervical region. However, dissection and traction around important structures make the procedure complicated and increase the chance of nerve injury. OBJECTIVE:To evaluate the clinical curative effect and safety of an innovative operative technique in which a polyetheretherketone cage was used to perform cervical spinal fusion for the treatment of Hangman’s fracture. METHODS: Eight patients with type II or IIa Hangman’s fracture were enroled in this study and received cervical fusions at C2/3 levels. During folow-up postoperatively, they received X-ray examination. Fusion time and implant position were evaluated. The angle of deformity (α) and the displacement distance (β) were compared pre-operatively and 6-month post-operatively to measure reduction. The functional outcomes were also compared using the Post-Traumatic Neck Score (Mayo) pre-operatively and 6-month post-operatively, while neck pain was further investigated by Visual Analogue Scale score. RESULTS AND CONCLUSION:Al eight patients were folowed-up successfuly, with an average folow-up of 13 months (range 6-26 months). Compared with pre-operatively, Clinical Post-Traumatic Neck Score (Mayo) was increased, Visual Analogue Scale score, angle deformity (α) and displacement distance (β) were reduced at 6-month post-operatively (P < 0.05). Neck activity was not limited in final folow-up. Bone fusion was found in al patients at 3 or 6 months post-operatively, and no complication was detected. Results confirm that polyetheretherketone cage for type II and IIa Hangman’s fracture could achieve good outcomes and safety.