C2-3 posterior screw-rod fixation combined with C2 spinous process-muscle-vascellum complex transplantation for unstable Hangman fracture

English Keywords:Hangman fracture  C2 spinous process  Muscle-vascular  Bone graft

English Abstract:

  【Abstract】 Objectives: To assess the clinical outcomes of C2-3 posterior screw-rod fixation combined with C2 spinous process-muscle-vascellum complex transplantation for unstable Hangman fracture. Methods: The study included 7 cases of unstable Hangman fracture treated between September 2014 and August 2015. There were 5 males and 2 females whose age ranged from 27 to 62 years old(mean, 43±12.7 years old). Six cases were diagnosed with Hangman Ⅱ fracture and one case was Hangman ⅡA fracture. X-ray, CT scan reconstruction and MRI were evaluated before operation. All the patients were treated with one stage C2-3 posterior screw-rod fixation combined with C2 spinous process-muscle-vascellum complex transplantation. Preoperative and postoperative Japanese Orthopedic Association(JOA) scores, the degree of axial symptom were recorded and compared. Results: All the patients were followed up. The follow-up time ranged from 9 to 15 months(mean, 10.5±1.6 months). Postoperative cervical spine X-ray and CT showed that the cervical spine alignment was restored. The dynamic X-ray showed no instability of cervical spine. The time of bone fusion in CT scan ranged from 5 to 10 months(mean, 7.1±1.3 months). The improvement rate of JOA scores at 1 week after operation of (23.1±10.5)% was significantly smaller than that at 6 months after operation of (50.2±15.7)%. The results of axial symptom was satisfactory in 4 patients and acceptable in 3 patients. Conclusions: The C2-3 posterior screw-rod fixation combined with C2 spinous process-muscle-vascellum complex transplantation for unstable Hangman fracture is effective. This procedure can preserve muscle intact and cervical stability.