| 手术治疗老年骨质疏松非典型不稳定性Hangman骨折 |
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投稿时间：2019-01-08
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| 作者 | Author | 单位 | Address | E-Mail |
| 陈华燕 |
CHEN Hua-yan |
重庆市开州区人民医院骨科, 重庆 405400 |
Department of Orthopaedics, People's Hospital of Kaizhou, Chongqing 405400, China |
Laochen72@163.com |
| 罗美琼 |
LUO Mei-qiong |
重庆市开州区人民医院骨科, 重庆 405400 |
Department of Orthopaedics, People's Hospital of Kaizhou, Chongqing 405400, China |
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| 李威 |
LI Wei |
重庆市开州区人民医院骨科, 重庆 405400 |
Department of Orthopaedics, People's Hospital of Kaizhou, Chongqing 405400, China |
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| 张毅 |
ZHANG Yi |
重庆市开州区人民医院骨科, 重庆 405400 |
Department of Orthopaedics, People's Hospital of Kaizhou, Chongqing 405400, China |
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| 期刊信息：《中国骨伤》2019年，第32卷，第7期，第641-646页 |
| DOI：10.3969/j.issn.1003-0034.2019.07.011 |
| 基金项目: |
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中文摘要:目的：探讨手术复位内固定治疗老年骨质疏松非典型不稳定性Hangman骨折的临床疗效。
方法：对2012年12月至2017年12月收治的9例老年骨质疏松非典型不稳定性Hangman骨折患者进行回顾性分析，其中男5例，女4例；年龄65~79岁，平均72.7岁。骨折类型：骨折线位于双侧下关节面或椎板伴枢椎前脱位3例（近似Levine-Edwards分型Ⅱ型）；骨折线一侧位于下关节面而对侧累及上关节面、枢椎椎体伴寰枢侧块关节脱位4例；骨折线位于枢椎椎弓根、横突孔及椎体后下壁伴有前后纵韧带、C2-C3椎间盘损伤致使C2-C3椎间失稳2例。术前脊髓损伤ASIA分级，D级2例，E级7例。术前JOA评分9~11分，平均9.8分。9例患者入院后常规行颅骨牵引复位，对伴有枢椎前脱位的3例患者采取Ⅰ期前后路联合内固定手术治疗，其余6例患者采取单纯后路内固定术。术后根据JOA评分标准、ASIA标准分级及影像学资料评价其疗效。
结果：9例患者均获随访，时间12~20个月，平均18个月。所有患者术后颈痛消失，颈椎活动良好，术后3个月JOA评分改善率为75%~87.5%。2例ASIA分级D级患者完全恢复至E级。术后6~12个月复查CT均获得骨性愈合。除1例术后出现喉上神经损伤表现3个月后完全恢复外，其余患者均无脊髓及椎动脉损伤、钢板螺钉松动、切口感染等并发症发生。
结论：根据老年骨质疏松非典型不稳定性Hangman骨折类型采取合理个性化手术方案治疗，术后可获得即刻稳定及良好复位，有利于早期活动快速康复，临床疗效满意。 |
| 【关键词】颈椎 骨质疏松 Hangman骨折 内固定 复位 外科手术 |
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| Surgical treatment of atypical unstable Hangman fracture in elderly osteoporotic patients |
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ABSTRACT Objective:To explore the clinical effect of operative reduction and internal fixation in treating atypical unstable Hangman fracture in elderly osteoporotic patients.
Methods:The clinical data of 9 elderly osteoporotic patients with atypical unstable Hangman fracture treated from December 2012 to December 2017 were retrospectively analyzed. There were 5 males and 4 females with an average age of 72.7 years (range 65 to 79) old. The fracture line was located on bilateral inferior articular surface or lamina with anterior dislocation of axis in 3 cases (similar to Levine-Edwards type Ⅱ); one side of the fracture line was located on the lower articular surface and opposite side involved on the upper articular surface and the body of axis with atlantoaxial lateral mass dislocation in 4 cases; the fracture line was located at the pedicle of the axis,transverse foramen and posterior inferior wall of the vertebral body,accompanying by anterior and posterior longitudinal ligaments and C2-C3 intervertebral disc injury resulted in C2-C3 intervertebral instability in 2 cases. According to ASIA grade of spinal cord injury,2 cases were grade D and 7 cases were grade E. Preoperative JOA scores were 9 to 11 points with an average of 9.8 points. All patients underwent routinely skull traction for reduction. Three patients with anterior dislocation of axis were treated with stage I anterior-posterior internal fixation and 6 patients with simple posterior pedicle screw fixation. Postoperative JOA score,ASIA system and the imaging data were used to evaluate clinical effects.
Results:All patients were followed up from 12 to 20 months with an average of 18 months. The neck pain disappeared after operation and cervical spine movement was well in all patients. The improvement rate of JOA at 3 months after operation was 75% to 87.5%. Two cases of ASIA grade D fully recovered to grade E. All fractures healed at 6 to 12 months after operation. Except one case occurred superior laryngeal nerve injury and had a complete recovery after 3 months,the other patients had no complications like spinal cord and vertebral artery injury,plate screw loosening and wound infection.
Conclusion:According to the type of atypical unstable Hangman fracture in elderly osteoporotic patients,choosing a reasonable and personalized surgical plan can achieve immediate cervical stability and well reduction,which is beneficial for early ambulation and quick rehabilitation. |
| KEY WORDS Cervical vertebrae Osteoporosis Hangman fracture Internal fixation Reduction Surgical procedures,operative |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陈华燕,罗美琼,李威,张毅.手术治疗老年骨质疏松非典型不稳定性Hangman骨折[J].中国骨伤,2019,32(7):641~646 |
| 英文格式: | CHEN Hua-yan,LUO Mei-qiong,LI Wei,ZHANG Yi.Surgical treatment of atypical unstable Hangman fracture in elderly osteoporotic patients[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(7):641~646 |
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