Treatment of unstable Hangman's fractures with pedicle and lateral mass screw fixation
- VernacularTitle:椎弓根及侧块螺钉内固定治疗不稳定性Hangman骨折
- Author:
Yong SHEN
;
Tongqing ZHANG
;
Yingze ZHANG
- Publication Type:Journal Article
- Keywords:
Axis;
Fracture;
Bones screws;
Fracture fixation, internal;
Skull traction
- From:
Chinese Journal of Orthopaedic Trauma
2002;0(02):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the technique and clinical effects of pedicle screw fixation in treatment of unstable Hangman' s fractures in comparison with the conservative managements. Methods From January 1999 to July 2005, 36 patients with unstable Hangman' s fractures were treated in our department. Based on Levine- Edwards classification, 15 of them were treated with skull traction, and others with internal fixation with posterior pedicle screws (C2,3 fusion in 10 cases and C2- 4 fusion in 11 cases). After a posterior midline incision and clear exposure of posterior structure, the C2 screw was inserted through the center of the posterior aspect of lateral mass, inclining usually 20? to 30? towards the head of the transverse plane and 25? to 35? inwards to the medial incline of the sagittal plane. For C3,C4 screw insertion, the drilling was parallel to the joint plane of the relevant vertebra and inclined 35? to 40? outwards to the medial incline of the sagittal plane. The whole procedure was performed under the monitoring of C- arm screen for safety and accuracy. Results A mean follow- up time was 18 months (5 to 28 months). 6 cases treated by skull traction lost their anatomic reduction. Of the 21 cases treated by the pedicle screw fixation, 2 had loosened internal fixation but 19 experienced no screw loosening and their fractures were cured entirely without limited function of the cervical vertebra. Conclusions In treatment of unstable Hangman' s fractures, C2,3 or C2- 4 pedicle screw fixation is an effective method to achieve rigid reduction and early rehabilitation. However, there is no remarkable difference between C2,3 fusion and C2- 4 fusion
