Selection of therapeutic methods and clinical results of Hangman′s fractures

English Keywords:Hangman fracture  Cervical vertebrae  Treatment  Outcome

English Abstract:

  【Abstract】　Objective：To explore the selection of therapeutic methods and clinical results of Hangman fracture through choosing reasonable treatment methods according to different fracture types.Method：All 29 cases with Hangman fractures were admitted to our hospital from Jan 2006 to Jun 2009.20 cases are male，and 9 cases are female.The age is from 17 to 74 years old.The average age is 32 years.According to Levine-Edwards typing：8 cases with type Ⅰ，12 cases with type Ⅱ，7 cases with type Ⅱa，2 cases with type Ⅲ.All the patients had Halo-vest or operation after tractionreduction.Type Ⅰ cases underwent Halo-vest.5 cases with type Ⅱ and 1 with type Ⅲ with compression on ventral dural sac were managed with anterior approach combined with intervertebral disc resection of C2-3 and bone grafting，plate internal fixation（the way of operation A）.5 type Ⅱa cases without compression were treated with posterior pedicle screw fixation at C2（the way of operation B）.2 cases with type Ⅱa and 7 cases with type Ⅱ and 1 case with type Ⅲ were managed with posterior C2-3 bone grafting fusion and screw-plate/stick fixation（the way of operation C）.According to the X-ray of cervical vertebra，clinical symptom，activity function of cervical vertebra to evaluate the treatment results.Result：All cases were followed up for 6-40 months.The average is 18 months.Of 8 cases with Halo-vast treatment，5 cases showed union of fracture at 12 weeks with excellent curative effect，2 cases acceptable，and 1 case bad（There was nonunion of fracture，then it was treated with the way of operation A.12 weeks later，it showed C2-3 bone grafting fusion and got good effect assessment）.All 6 cases with the way of operation A and 5 type Ⅱa cases with the way of operation B showed C2-3 bone grafting fusion after 12 weeks.Among 10 cases treated with the way of operation C，1 type Ⅱ developed nonunion，1 type Ⅱ had malunion，and 8 cases had union.Conclusion：Most patiens who had Hangman fracture through different treatment ways can get good treatment effect according to Levine-Edwards typing.