[摘要] 目的 评介椎弓根螺钉内固定治疗枢椎椎弓骨折（Hangman骨折）的临床应用价值。方法 回顾性分析我科自1999年以来收治的急性枢椎椎弓骨折15例患者，其中Ⅰ型4例，Ⅱ型11例，均合并不同程度神经系统症状，行颅骨牵引复位后用AO纯钛皮质骨螺钉经峡部固定枢椎椎弓骨折。结果 经平均1年以上随访，术后神经功能恢复按Frankel分级有6例D级和5例C级恢复至E级，2例C级恢复至D级，1例B级恢复至C级，1例B级恢复至D级，半年后复查X线骨折均愈合，复位良好，无椎动脉损伤及其它术中、后并发症。结论 椎弓根螺钉内固定治疗早期枢椎椎弓骨折，复位固定满意，促进脊髓功能的恢复，且较少影响上颈椎功能。
[关键词]　椎弓根螺钉；枢椎椎弓骨折（Hangman骨折）；脊髓损伤　
Using of Pedicle screw fixation in treatment on acute hangman＇s fracture and spinal cord injury TANG li-xin, SONG ying-chao, Wang li-na.. Department of Orthopaedics，Nanyang central Hospital, Nanyang City,Henan 473009,china
[Abstract] Objective To evaluate the clinical outcomes of using pedicle screw fixation in the treatment of hangman＇s fracture. Methods Retrospective analysis the trement of 15 patients wth acute hangman＇s fracture since 1999, four of them wereⅠtype, eleven cases wereⅡtype. and all patients in different degrees presenting with nerve system symptom were treated by AO pure titanium cortex screw through isthmus after skull traction replacement. Result After above one year, all patients were given the following up examination according to Frankle classification. Six D grade cases and five C grade cases recovered up to E grade, two C grade cases recovered to D grade, one B grade case recovered to C grade and another B grade case recovered to D grade. X-ray showed all fracture have healed up without vertebra artery injury and other complications. Conclusion The outcomes of diaplasis and fixation by using pedicle screw fixation in treatment on acture hangman＇s fracture were satisfaction, and this clinical technique can promot functional recovery of spinal cord, decrease the rate of infection and less affect the function of uper cervical spine.
[Key words] Pedicle screw; Hangman’s fracture; Spinal cord injury
　　枢椎椎弓骨折是一种少见的上颈椎损伤，亦称Hangman骨折，多因交通事故或高空坠落致伤。我院自1999年以来采用颈后路切开复位，椎弓根螺钉内固定治疗15例，疗效满意。
临床资料
一、一般资料
       本组15例均为男性，年龄2346岁，平均34.5岁。致伤原因：车祸5例，高处坠落6例，其它4例。颈部影像学（X线、CT、MRI）显示： C2双侧椎弓骨折，椎体向前滑脱10％50％不等，其中Ⅰ型4例，Ⅱ型11例，均合并不同程度神经系统症状, 脊髓损伤按Frankel分级：B级2例，C级7例，D级6例。
二、典型病例
      患者，男，23岁，高处坠落致伤，6h后入院，入院时生命体征尚平稳，颈痛，颈部活动受限，右肩部痛觉过敏，右上肢麻木，右上肢肌力Ⅰ级，双下肢感觉、运动正常，大小便正常，病理反射未引出。X线片示C2双侧椎弓骨折，C2椎体向前滑脱20％，CT示：C2双侧椎弓骨折合并C3右侧椎板骨折，MRI示：C2椎体向前滑移，脊髓无明显受压及挫伤。经牵引、颈后路切开复位、C2椎弓根螺钉内固定配合药物治疗，术后颈围保护3个月，出院时右上肢麻木消失，右上肢肌力Ⅳ级，半年后完全恢复正常，一年随访X线骨折愈合、复位良好。
三、手术方法
入院后经体检及影像学检查明确诊断后即行颅骨牵引，应用脱水剂、激素等药物治疗，分别于伤后612d行颈后路切开复位、C2椎弓根螺钉内固定术。手术在局麻下进行，显露C1～C6及枕骨区，剥离环椎后弓并将枢椎椎弓后半部显露清楚，先用神经剥离子定位C2椎板上缘及椎弓内侧缘，进针点选在椎弓根内侧缘外侧7mm，距椎板上缘5mm，进针方向向内呈30°，向上呈20°，进钉深度根据术前CT片测量为2630mm 。复位时可用组织钳固定环椎后弓向后牵拉，矫正枢椎椎体前脱位，同时推顶枢椎的棘突、椎弓，使椎弓根骨折复位并用巾钳固定，用直径3.0mm的开口手钻从关节突进钉点骨皮质钻孔，经椎弓根峡部达C2椎体皮质下，然后用直径3.5mm的丝锥攻丝，取直径为3.5mm的AO皮质骨钛质螺钉拧入，两侧操作方法相同，切口置负压引流，颈围固定3个月。
四、治疗结果
所有患者均获随访，随访时间12～60个月，平均18.6个月，术后神经功能恢复情况：D级6例和C级5例均恢复至E级，C级另外2例恢复至D级，B级1例恢