Anterior Restoration And Fusion With The Internal Fixation For Treatment Of Type Ⅱ A、 Ⅱ Hangman’s Fracture

Background and Objective:Anterior cervical discectomy and fusion(ACDF),was an optimal surgical technique forcervical spondlotic myelopathy,With the development of the internal fixation technology in recent years,anterior C2、3 fusion and internal fixation was widely used in the treatment of type II a, II Hangman fractures.But at present still have considerable debate on its curative effect.reconstruction of anterior cervical column after corpectomy. In present study, we conducted the mid-and long-term follow-up of patients with type II a, II Hangman fractures who underwent the uniplate for anterior fusion and internal fixation.To investigate the treatment of such fracture and a Safe and reliable anterior cervical internal fixation materials.Methods:There were 17patients with hangman fracture,from 2009 to 2013 in our hospital were reviewed retrospectively. According to the classification system designed by Levine and Edwards, type I in 1 cases,type II in 12cases, type II a in 4 cases.3 cases have spinal injury before operation, According to American spinal injury association (ASIA) system,was at Type D,the rest were at Type E.Part of this cases underwent skull traction for close reduction,then treated with anterior C2-3 discectomy followed by insert n-HA/PA66 interbody fusion cage for fusion and anterior uniplate fixation.Using Visual Analogue Scale (VAS)、 American spinal injury association (ASIA) system and the imaging data for a comparative analysis.Results:All of 17 patients were followed up for 12months to 3years. All bone grafts acquired stable fusion or bone healing with no C2/C3 instability, there was no obvious postoperative complications.The neurological functions were restored satisfactorily, ASIA score from D to E. 15patients neck pain was relieved but 2 patients residual neck pain after anterior surgeries. Neck pain was assessed by VAS,preoperative, postoperative 1 week and the last follow-up respectively (3.90±0.62)、 (1.32±0.80)、(0.57±0.94),(P＜0.05)。 Translation of C2 and Angulation of C2、3,preoperative, postoperative 1 week and the last follow-up respectively(5.41±4.47)°、(3.17±1.50)mm; (2.05±1.95)°、(1.00±0.79) mm; (2.05±2.19)°、(1.05±0.74) mm, Compared with the preoperative, postoperative 1 week (P＜0.05).Compared with the postoperative 1 week and the last follow-up (P>0.05)。Conclusions:1、The utilization of uniplate for anterior C2、3 reduction、fusion and internal fixation can recover the normal tract of cervical vertebra immediately achieve good clinical efficacy in hangman fractures,but preoperative must be strictly grasp the operation indication.2、On some type II a, II Hangman fractures,with serious damage of articular process joint may be need combined anterior-posterior approach.3、When using the uniplate for anteriorC2、3 reduction、fusion and internal fixation,the Stability can meet the clinical requirements; better maintain the reduction and low internal fixation related complications in long-term follow-up.