中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (9): 1848-1854.doi: 10.12307/2025.120

• 数字化骨科Digital orthopedics • 上一篇    下一篇

后路C2-3固定结合顶棒置入与单纯后路C2-3固定治疗不稳定Hangman骨折的比较

张  浩，王  清，张  建，李广州，王高举   

  1. 西南医科大学附属医院骨科，四川省泸州市   646000
  • 收稿日期:2023-11-27 接受日期:2024-01-13 出版日期:2025-03-28 发布日期:2024-10-10
  • 通讯作者: 王高举，硕士，副主任医师，西南医科大学附属医院骨科，四川省泸州市 646000 李广州，博士，副主任医师，西南医科大学附属医院骨科，四川省泸州市 646000
  • 作者简介:张浩，男，1996年生，四川省宜宾市人，汉族，西南医科大学在读硕士，医师，主要从事脊柱外科方面的研究。
  • 基金资助:
    泸州市人民政府——西南医科大学科技战略合作项目 (2020LZXNYDJ40)，项目负责人：王高举

Comparison of posterior C2-3 fixation combined with bucking bar technique and posterior C2-3 fixation alone in treatment of unstable Hangman fractures

Zhang Hao, Wang Qing, Zhang Jian, Li Guangzhou, Wang Gaoju   

  1. Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
  • Received:2023-11-27 Accepted:2024-01-13 Online:2025-03-28 Published:2024-10-10
  • Contact: Wang Gaoju, Master, Associate chief physician, Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China Li Guangzhou, PhD, Associate chief physician, Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
  • About author:Zhang Hao, Master candidate, Physician, Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
  • Supported by:
    Luzhou Municipal People’s Government-Southwest Medical University Science and Technology Strategic Cooperation Project, No. 2020LZXNYDJ40 (to WGJ)

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摘要：


文题释义：

Hangman骨折：是指枢椎上、下关节突之间的部分在暴力作用下发生的骨折，常伴周围韧带和椎间盘损伤，继而出现枢椎椎体不稳或脱位，又称为枢椎创伤性滑脱。其发病率占 C2 骨折的20%-22%，占所有颈椎骨折的4%-7%。Hangman骨折神经损伤的概率为6.5%-23%。
疼痛目测类比评分：在纸上面划一条10 cm的横线，横线的一端为0 cm，表示“完全无痛”；另一端为10 cm，表示“疼痛到极点”；疼痛程度由0 cm到10 cm逐级递增，评分越高代表疼痛程度越剧烈。该方法用于患者的疼痛程度评估、不同时间的疼痛评估、治疗后的疼痛程度对比等。

摘要
背景：Hangman骨折中Ⅱ、ⅡA、Ⅲ型常需手术治疗，手术方式选择存在较大争议，目前均存在术后复位不全及畸形愈合等不足；前期作者团队使用C2-3拉力螺钉结合经口顶棒技术间歇性推顶C2椎体治疗不稳定Hangman骨折，取得了满意的临床疗效，但前期研究样本少，且缺少对照组比较。
目的：比较后路C2-3固定结合经口顶棒技术和单纯后路C2-3固定治疗不稳定Hangman骨折的临床疗效。
方法：回顾性分析西南医科大学附属医院收治的行后路C2-3固定手术治疗的55例不稳定Hangman骨折患者临床及影像学资料，根据手术方案分为2组，其中23例患者接受后路C2-3固定结合经口顶棒技术治疗(A组)，32例接受单纯后路C2-3固定术(B组)。比较两组患者的手术时间、术中出血量、并发症、术前及末次随访时疼痛目测类比评分、颈椎功能障碍指数、美国脊髓损伤协会脊髓损伤分级和患者满意度(Odom’s分级)；另外对比各观察时间点C2-3移位和成角及其他影像学指标的变化。

结果与结论：①两组患者手术时间、术中出血量和术后并发症发生情况比较差异无显著性意义(P > 0.05)；②两组患者末次随访颈痛目测类比评分和颈椎功能障碍指数较术前获得显著改善(P < 0.05)，Odom’s分级显示A组优良21例(91%)；B组优良29例(91%)；两组各项临床疗效指标比较差异均无显著性意义(均P > 0.05)；③两组术前C2-3成角和位移差异无显著性意义(P > 0.05)；术后及末次随访时，两组患者C2-3成角和位移均较术前明显减小，差异有显著性意义(P < 0.01)；术后和末次随访上述指标比较差异无显著性意义(P > 0.05)；术后及末次随访时，A组C2-3位移和成角较B组明显减小，差异有显著性意义(P < 0.05)；④末次随访时，A组患者均未发生残余畸形，B组发生残余畸形4例(13%，4/32)；⑤因此，后路C2-3固定结合经口顶棒技术可能有利于枢椎体复位和稳定，减少畸形愈合，获得更好的复位。


中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


关键词: Hangman骨折, 顶棒技术, 后路拉力螺钉, 骨折复位, 内固定

Abstract:

BACKGROUND: Types II, IIA, and III of Hangman fractures often require surgical treatment, and the selection of surgical methods is controversial. Current surgeries have shortcomings such as incomplete reduction and malunion after surgery. In the early stage, our team used C2-3 lag screws combined with a bucking bar. Intermittent pushing of the C2 vertebral body in the oropharynx has achieved satisfactory clinical results. However, the preliminary studies included few samples and lacked a control group for comparison.

OBJECTIVE: To compare the clinical efficacy of posterior C2-3 fixation combined with the bucking bar technique and posterior C2-3 fixation alone in the treatment of unstable Hangman fractures.
METHODS: The clinical and imaging data of 55 patients with unstable Hangman fractures who underwent posterior C2-3 internal fixation in Affiliated Hospital of Southwest Medical University were retrospectively analyzed. According to the surgical plan, the patients were divided into two groups. Among them, 23 patients received posterior cervical C2-3 internal fixation combined with the bucking bar technique (group A), and 32 patients received simple posterior C2-3 internal fixation (group B). Operation time, intraoperative blood loss, complications, pain visual analog scale score, neck disability index, American Spinal Injury Association classification, and patient satisfaction (Odom’s classification) preoperation and during follow-up were compared between the two groups. The changes in C2-3 displacement and angulation and other imaging indicators were compared at each observation time point.

RESULTS AND CONCLUSION: (1) There was no statistically significant difference in operation time, intraoperative blood loss, and postoperative complications between the two groups (P > 0.05). (2) The neck pain visual analog scale and neck disability index scores of the two groups of patients at the final follow-up were significantly improved compared with those before surgery (P < 0.05). The Odom standard classification showed that 21 cases (91%) in group A were excellent and 29 cases (91%) were excellent and good in group B. There was no statistically significant difference in the clinical efficacy indicators between the two groups (all P > 0.05). (3) There was no significant difference in C2-3 angulation and displacement between the two groups before operation (P > 0.05). Postoperation and at the last follow-up, the angle and displacement of C2-3 in both groups were significantly smaller than before surgery, and the difference was statistically significant (P < 0.01). There was no statistically significant difference in the above indicators after surgery and at the last follow-up (P > 0.05). After surgery and at the last follow-up, the displacement and angle of C2-3 in group A were significantly smaller than those in group B (P < 0.05). (4) At the last follow-up, no patients in group A had residual deformity, and 4 cases (13%, 4/32) in group B had residual deformity. (5) Therefore, posterior C2-3 fixation combined with transoral bucking bar technology may be beneficial to the reduction and stabilization of the vertebral body, reduces malunion, and can achieve better reduction.


中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Hangman’s fracture, bucking bar technique, posterior lag screw, fracture reduction, internal fixation

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