| Objective:To review the current literatures and to analysis of clinical cases, approach the definition, pathogenesis, clinical type, stability, and the treatment strategies of Hangman's fracture.Methods:The study collected 10 cases of Hangman's fracture in the 1st hospital of JiLin University from October 2008 to February 2011. Their clinical information and long-term follow-up are all complete. All patients routinely took cervical X-ray, cervical three-dimensional CT. And 8 of them took MRI examination. According to Levine-Edwards classification criteria, there were 2 cases of typeâ… Hangman's fracture and 5 of typeâ…¡and 3 of typeâ…¡A. There were no typeâ…¢cases. According to the spondylolisthesis and angulation of C2 and C3, the 10 cases all had skull tractions or other methods to reduce the fractures with starting weight 2 kg, through 3-21 days and an average of 8 days. One case of type I fracture had Halo vest external fixation; the other one with C2-3 intervertebral disc damage had the operation of posterior C2-3 vertebral pedicle screw internal fixation and fusion. One case of type II combined with margin of C2 vertebral body fracture had Halo vest external fixation; One case combined with the lower edges of the C2 and C3 vertebral fractures had an operation of anterior C2-3 disc removal internal fixation and fusion; 3 other type II patients were treated by posterior C2-3 pedicle screw fixations and bone fusions. One case of type IIA fracture had undertook a posterior C2 pedicle screw and C3 lateral mass fixation and fusion surgery; One had a posterior C2-3 pedicle screw fixations and bone fusion; And one took an anterior C2-3 disc removal internal fixation and fusion, then being turned over and given a posterior C2-3 pedicle screw fixations and bone fusions. Conservative treatment of typeâ… and typeâ…¡fractures with Halo vest fixation took 16-20 weeks and surgery patients would wear neck collars of 2-12 weeks.1 week follow the surgeries they all took X-ray and three-dimensional CT and X-ray for every 4 weeks after discharge until the fusion of fractures.Results:The group of 10 patients were followed up for 2-28 months, with an average of 12 months. Only 2 cases were still in the treatment, and the remaining 8 cases all were bony union with an average healing time of 3-4 months.1 case of typeâ… conservative treatment removed the Halo vest in 4 months and was followed up for 6 months without significant instability.1 case of typeâ…¡conservative patients were followed up for 4 months, ASIA score improved from D to C, with limb muscles'strength recovery and only the numbness of left hand.8 cases of surgical treatments of postoperative through X ray and CT showed that fracture and dislocation had been reduced.1 patient is still being followed up. The other 7 cases all didn't have screws or plates loosening and bone graft and cervical spine stability were all good. There were not dizziness, headache and other symptoms, or spinal cord or vertebral artery injuries. There were not cerebrospinal fluid leakages or complications such as wound infections.Conclusion:1 All patients of hangman's fracture should routinely have cervical lateral X-ray, three-dimensional CT and MRI examinations. If the conditions permit, they also should have dynamic X-rays followed by doctors.2 Typeâ… fractures of the conservative treatment can achieve good effects.But when the C2-3 disc were damaged, they can have a posterior C2-3 pedicle screw fixations and bone fusion surgery for prevention of long-term instability.The long-term effects needs further observation.3 An operation of posterior C2-3 pedicle screw fixations and bone fusion is an effective treatment for the typeâ…¡A andâ…¡fractures. While for typeâ…¡fractures, if the discs were damaged, an anterior C2-3 disc removal internal fixation and fusion operation should be the first choice. If accompanied by significant damage, serious dislocation and angulation, the anterior and posterior combined approach should be the first choice. |
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