颈椎前路减压内固定术治疗不稳定的Hangman骨折

发布时间：2018-01-24 02:20

本文关键词： Hangman骨折前路疗效　出处：《福建医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究目的:通过对国内外文献报道和福建附属第一医院的Hangman骨折临床病例进行回顾性分析,回顾性观察不稳定的hangman骨折前路治疗的疗效及相关性研究。研究方法:本研究收集了2009年-2014年我校附属第一医院的Hangman骨折患者病例,排除未能定期随访及后路手术的病例,其中采用C2,3前路减压融合治疗hangman骨折18例,临床资料完善并且定期随访。所有患者术前均行颈椎正侧位片、颈椎CT平扫三维重建、颈椎磁共振等相关检查。根据Levine-Edwards分型标准,其中II型9例,IIA型9例,无III型病例。术前根据骨折的损伤机制及移位、成角情况等进行持续颅骨牵引,时间2-7天,重量约2-4KG.定期行颈椎正侧位片复查,根据情况对牵引进行实时调整。均行C2,3前路减压融合术,利用ASIA评分及术后影像学复查评价疗效。结果:所有病例获得3-50个月随访,平均26个月,未出现明显不稳。影像学复查均获得骨性融合,未出现手术相关并发症,14例术前神经功能正常患者,术后无神经损害;4例不全瘫患者均有不同程度等恢复。结论:1.Hangman骨折患者入院需常规行颈椎正侧位片、颈椎CT三维重建及磁共振检查,明确骨折分型及椎间盘、脊髓损伤相关情况,对于后期手术方案的制定至关重要。2.对于II型及IIA型的hangman骨折,行“C2,3前路减压融合”起到减压的效果,并且重建了颈椎的生理曲度,稳定了前中柱,对颈椎复位的维持较稳定。
[Abstract]:Objective: to analyze retrospectively the clinical cases of Hangman fracture in the first affiliated Hospital of Fujian Province through the literature reports at home and abroad. Retrospective study on the efficacy and correlation of anterior approach to unstable hangman fracture. Methods:. Cases of Hangman fracture were collected from 2009 to 2014 in the first affiliated Hospital of our University. 18 cases of hangman fracture were treated with C2T3 anterior decompression fusion. The clinical data were perfect and followed up regularly. All the patients underwent anterior and lateral cervical vertebrae radiography before operation and three-dimensional reconstruction with plain CT scan of cervical spine. According to Levine-Edwards classification criteria, 9 cases of type II type IIA, no cases of III type. Preoperative according to the fracture injury mechanism and displacement. Continuous cranial traction was performed for 2-7 days with a weight of about 2-4 KG. The cervical vertebrae axial and lateral radiographs were re-examined regularly and the traction was adjusted in real time according to the situation. All patients were treated with C2A3 anterior decompression and fusion. Results: all the patients were followed up for 3-50 months with an average of 26 months without obvious instability. No postoperative complications were found in 14 patients with normal nerve function before operation, and no nerve damage was found after operation. Conclusion: 1. The patients with Hangman fracture should be treated with axial and lateral cervical radiography, three-dimensional CT reconstruction and magnetic resonance imaging. Clear classification of fractures and disc, spinal cord injury related conditions, for the formulation of post-operative plan is very important .2. for type II and IIA type of hangman fractures, with "C2". (3) anterior decompression fusion had the effect of decompression, and reconstructed the physiological curvature of the cervical spine, stabilized the anterior and middle column, and maintained the stability of the reduction of the cervical vertebrae.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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