Hangman骨折的诊断与治疗

Diagnosis and Treatment of Hangmans Fracture

目的探讨Hangman骨折的病理特点、临床表现、诊断以及治疗方案的选择。方法收集19例Hangman骨折的临床资料,男15例,女4例,分析其损伤机制、影像学表现、骨折分型及治疗方法的选择。结果手术治疗11例,非手术治疗8例;2例失访,17例得到随访,时间为6～36个月,结果为骨折均愈合或植骨均融合。结论X线片、CT扫描及MRI检查是Hangman骨折必要的诊断措施;Ⅰ型行非手术治疗而愈,Ⅱ型根据复位情况考虑行手术或非手术治疗,合并有C2～3急性椎间盘突出损伤颈髓的Ⅱ型和ⅡA型骨折以及Ⅲ型骨折则应行手术治疗。

Objective To study the pathological characteristics, clinical manifestations, diagnosis and treatment of Hangman＇s fracture. Methods Nineteen patients with Hangman＇s fracture treated at our hospital were retrospectively analyzed. Results Fourteen patients were injured in motor vehicle accidents, two in fall from high places, two by hiring on the neck and one in physical jerks. According to Leving- Edwards＇ classification on Hangman＇s fracture, type Ⅰ in five patients, type Ⅱ in nine, type Ⅱ A in three and type m in two were found. Eleven patients underwent operation and eight received non- operative treatment. Seventeen patients followed up for 6 to 36 months were cured. Conclusion CT and MRI are required in the course of diagnosis for Hangmaffs fracture. Conservative treatment may be applicable for the fractures of type Ⅰ and type Ⅱ , but those of type Ⅱ or type Ⅱ A accompanied with acute C2-3 disc herniation injuring spinal cord or type m require surgical intervention.