C2,3椎弓根螺钉固定融合治疗不稳定型Hangman骨折

目的：探讨C2，3椎弓根螺钉固定融合术治疗不稳定型Hangman骨折的疗效。方法2006年4月～2013年3月，采用C2，3椎弓根螺钉固定融合术治疗不稳定型Hangman骨折患者8例。根据Levine分型标准Ⅱ型骨折6例，ⅡA型骨折2例。手术均采用OASYS内固定系统，并在C2，3椎板及关节突间植骨。为确保安全及准确，所有操作在C形臂X线机导航下完成。术后平均随访18个月，采用正侧位、动力位X线片及CT扫描评估固定融合节段的完整性和稳定性。结果8例患者颈椎骨折均获得满意复位，术中无一例发生脊髓及椎动脉损伤。术后1例切口愈合不良，经换药后愈合。末次随访时影像学检查显示患者均获得骨性愈合。随访期间所有患者无螺钉松动、断裂等并发症发生。结论 C2，3椎弓根螺钉固定融合术是治疗不稳定型Hangman骨折的有效方法，可以复位骨折并使之达到骨性愈合，并发症发生率低。

C2,3 pedicle screw fixation and fusion for unstable Hangman's fractures

Objective To evaluate the clinical efficacy of posterior C2,3 pedicle screw fixation and fusion in the treatment of unstable Hangman’ s fracture.Methods From April 2006 to March 2013, 8 patients with unstable Hangman’ s fracture were treated with posterior C2,3 pedicle screw fixation and fusion.According to Levine classification, 6 cases were graded as Type-Ⅱand 2 cases Type-ⅡA.The OASYS internal fixation system were implanted between C2,3 segments through posterior midian longitudinal incision after pamplegia.Bone grafting was done between C2,3 lamina and facet.C-arm fluoroscopy was used for the whole procedure to ensure the safety and accuracy.All patients were followed up for 9-36 months （ averaged 18 months） postoperatively.Static and dynamic radiographs combining with CT scans were used to assess graft-complex integrity and stability.Results Eight patients with unstable Hangman’ s fracture achieve satisfactory reduction postoperatively.There was no spinal cord or vertebral artery injury intraoperatively.One case suffered from faulty union and resolved after dressing change.At the final follow-up, all cases were proved to obtain bony fusion and segmental stability by imaging examinations. There was no complications such as screw loosening or breakage during the entire follow-up period.Conclusion Posterior C2,3 pedicle screw fixation and fusion is an effective technique for the treatment of unstable Hangman’ s fracture, proving its value for achieving fracture reduction and solid bony fusion combined with a low rate of complications.