Hangman骨折的稳定性评价及疗效分析

Evaluation of stability and clinical results of Hangman＇ s fractures

目的 探讨复杂类型Hangman骨折的治疗方法选择，并分析其疗效。方法 本组23例，男15例，女8例；年龄19～54岁，平均36岁。根据是否有合并损伤分为两组：A组（单纯Hangman骨折）11例；B组（复杂类型Hangman骨折）12例，其中合并Jefferson骨折和C1,2不稳4例，合并C6,7骨折脱位6例。Hangman骨折按Levine-Edwards分类法，A组：Ⅰ型4例，Ⅱ型3例，ⅡA型3例，Ⅲ型1例；B组：Ⅰ型3例，Ⅱ型7例，ⅡA型1例，Ⅲ型1例。A组Ⅰ、Ⅱ型采用保守治疗，ⅡA、Ⅲ型手术治疗；B组中，合并Jefferson骨折和C1,2不稳4例，采用后路颈枕融合（从枕骨到C2），合并C6,7骨折脱位6例患者的手术方法为前路C6,7内固定融合、头颈胸石膏固定。结果 23例患者均获得6个月～3年（平均为12个月）的随访。X线片提示所有患者均获得了骨性融合。A组、B组保守治疗的患者未出现C2,3不稳。手术治疗患者无内固定并发症（内置物松动、折弯、折断等）。无术后神经功能加重的患者。结论 对Hangman骨折合并C1骨折，若稳定性较好，可采用颈围或Halo-Vest支架固定；若同时伴C2,3间成角〉11°，固定融合范围应扩大到枕骨或行C1-3内固定融合。Hangman骨折合并下颈椎骨折脱位，若Hangman骨折为Ⅰ、Ⅱ、ⅡA型，则可仅行下颈椎手术，对Hangman骨折采用保守治疗。

Objective To discuss the selection of therapy for complex Hangman＇ s fractures and analyse its results. Methods There were 15 males and 8 females with average age of 36 years （ 19-54 years）. The fractures were classified according to Levine-Edwards system. All cases were divided into two groups： Group B associated with fractures in other parts of the cervical spine and Group A without. In Group B, there were four cases with Jefferson fracture and instability of atlantoaxis, six with C6 fracture and seven with dislocation. In Group A, there were four cases with type Ⅰ fractures, three with type Ⅱ, three with type Ⅱ A and one with type Ⅲ. In Group B, there were three cases with type Ⅰ fractures, seven with type Ⅱ , one with type Ⅱ A and one with type Ⅲ. In Group A,type Ⅰ and type Ⅱ fractures were treated with conservative method but type Ⅱ A and type Ⅲ treated with surgical procedure. In Group B, four cases associated with Jefferson fracture and instability of C1, 2 were treated with posterior fusion of occipital and C2. Six cases of C6,7 dislocation associated with Hangman＇ s fracture were treated with anterior C6,7 fusion and cephal-cervico-thorax plaster external fixation. Results Follow-up for 6-36 months （mean 12 months） and radiographs showed signs of solid fusion, with no C2/C3 instability in Groups A and B with conservative treatment. There was no implant failure （ loosening, bonding, or breakage of the screws） or neurological function deterioration. Conclusions Hangman＇ s fracture associated with C1 fracture but with stable cervix can be treated with collar or Halo-vest. For Hangman＇ s fractures associated with C1 fracture and with angulation between C2 and C3 over 11 °, fusion scope should be expanded to occipital bone or posterior fusion of C1-3 be considered. If Hangman＇ s fractures （ type Ⅰ , type Ⅱ, type Ⅱ A ） are associated with lower cervical spine fracture and dislocation, surgical treatment can yield good resuit.