Reduction and fixation by high anterior cervical approach for treatment of type II and type IIA Hangman's fractures

XIE Xueyi; PENG Xinsheng

doi:10.3969/j.issn.1674-666X.2014.02.004

Abstract：Objective To evaluate the clinical effects of reduction and fixation by high anterior cervical approach for treatment of type II and type IIA Hangman's fractures. Methods From January 2005 to May 2013, 21 patients with type II and type IIA hangman's fractures underwent C2-C3 discectomy, reduction and intervertebral fusion with internal fixation by high anterior cervical approach. The operative time and intraoperative estimate blood loss were recorded, C2-C3 lordosis angles at one week postoperatively and the final follow-up were determined respectively, and the reduction and complications were observed. Results The average operative time was 75 min (50-90 min), the intraoperative estimate blood loss was 20-100 mL, with the average of 55 mL. No intraoperative complications such as nerve or blood vessel injuries were observed. All patients achieved fixation successfully, and for 19 patients with anterior dislocation of C2, 16 patients achieved completely anatomic reduction and 3 of them functional reduction. The average angles of lordosis in C2-C3 at preoperation and postoperation were (-9 ± 2.5)° and (3.1 ± 0.8)° respectively which had statistical differences (P <0.05). Total of 19 patients were followed up with the average time of 3 years and 3 months (6 months to 7 years). The average angle of lordosis in C2-C3 at the last follow-up was (2.6 ± 0.5)°, no obvious loss of angle of lordosis were observed. Radiological results showed evidences of a solid C2-C3 intervetebral fusion. No internal fixation hardware loosening, pull-out or breakage were found during the follow-up. Conclusions Treatment of C2-C3 discectomy, reduction and fusion with internal fixation by high anterior cervical approach for type II and type IIA Hangman's fractures can improve and then maintain the angles of cervical lordosis, achieve satisfactory reduction, reliable fixation and fusion, and therefore good clinical effects.