RESEARCH PROGRESS OF DIAGNOSIS AND TREATMENT OF Hangman FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGBaocheng ^1,2 ,  CAIXianhua ^1,2 , DINGRan ¹ , KANGHui ¹

1. Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command of Chinese PLA, Wuhan Hubei, 430070, P. R. China;
2. Graduate School, Southern Medical University;

Corresponding author：

CAIXianhua, Email: wgcaixh@163.com

Keywords：

Hangman fracture; Internal fixation; Anterior approach; Cervical alignment

DOI：

10.7507/1002-1892.20150109

Video：

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Objective To review the research progress of the diagnosis and treatment of Hangman fracture. Methods The original articles about the diagnosis and treatment of Hangman fracture were extensively reviewed and analyzed. Results Not only X-ray, but also MRI and CT scans are necessory for the diagnosis and assessment of Hangman fractures. The treatment of unstable Hangman fracture included posterior C₂, C₃ fixation, anterior C₂, C₃ fixation, and anterior C₂, C₃ fixation combined with posterior C₂ pedicle screw fixation. The anterior surgical fixation is used by the anterior retropharyngeal approach or subaxial anterior approach, and it has the advantages of directly resecting the injured C₂, C₃ discs, getting a satisfactory cervical spine alignment, and avoiding the postoperative axial pain. However, posterior surgical fixation using C₂ pedicle screw has the risks of neurovascular injuries. Conclusion The surgical technique of Hangman fracture should be determined based on the patient's injury and surgeon's experience. Randomized control trials of different surgical techniques should be performed.

Citation： ZHANGBaocheng, CAIXianhua, DINGRan, KANGHui. RESEARCH PROGRESS OF DIAGNOSIS AND TREATMENT OF Hangman FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(4): 513-517. doi: 10.7507/1002-1892.20150109 Copy

1.	Effendi B, Roy D, Cornish B, et al. Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg (Br), 1981, 63-B(3):319-327.
2.	Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg (Am), 1985, 67(2):217-226.
3.	蔡贤华, 陈庄洪, 黄继锋, 等. Hangman骨折损伤病理特点及颈前路钢板内固定治疗. 临床外科杂志, 2007, 15(5):349-351.
4.	谢宁, 倪斌, 陈德玉, 等. 第2、3颈椎前路融合联合第2颈椎椎弓根固定治疗不稳定Hangman骨折. 中华外科杂志, 2008, 46(4):267-269.
5.	Xie N, Khoo LT, Yuan W, et al. Combined anterior C₂-C₃ fusion and C₂ pedicle screw fixation for the treatment of unstable hangman's fracture:a contrast to anterior approach only. Spine (Phila Pa 1976), 2010, 35(6):613-619.
6.	蔡贤华, 陈庄洪, 黄继锋, 等. 累及枢椎椎体的Hangman骨折七例报告. 中国骨与关节损伤杂志, 2009, 24(11):961-963.
7.	Samaha C, Lazennec JY, Laporte C, et al. Hangman's fracture:the relationship between asymmetry and instability. J Bone Joint Surg (Br), 2000, 82(7):1046-1052.
8.	谢宁, 倪斌, 袁文, 等. 前路C2,3复位融合治疗Hangman骨折. 中华骨科杂志. 2008, 28(8):634-637.
9.	Starr JK, Eismont FJ. Atypical hangman's fractures. Spine (Phila Pa 1976), 1993, 18(14):1954-1957.
10.	李浩淼, 刘少喻, 梁春祥, 等. 前路内固定治疗Ⅱ型及Ⅱa型Hangman骨折的疗效. 中国脊柱脊髓杂志, 2007, 17(2):107-110.
11.	Zhang YS, Zhang JX, Yang QG, et al. Surgical management of the fractures of axis body:indications and surgical strategy. Eur Spine J, 2014, 23(8):1633-1640.
12.	Yoshida G, Kanemura T, Ishikawa Y. Percutaneous pedicle screw fixation of a Hangman's fracture using intraoperative, full rotation, three-dimensional image (O-arm)-based navigation:a technical case report. Asian Spine J, 2012, 6(3):194-198.
13.	蔡贤华, 王威, 王志华, 等. 不同前路内固定方式治疗枢椎椎体横行骨折合并 Hangman 骨折稳定性的有限元分析. 中国脊柱脊髓杂志, 2014, 24(3):257-260.
14.	贾连顺, 李国. Hangman骨折. 中华骨科杂志, 2004, 24(5):317-320.
15.	贺瑞, 张文志, 尚希福, 等. 前路颌下血管神经间隙入路复位固定融合治疗Hangman骨折. 中国矫形外科杂志, 2012, 20(4):367-369.
16.	Wu YS, Lin Y, Zhang XL, et al. Management of hangman's fracture with percutaneous transpedicular screw fixation. Eur Spine J, 2013, 22(1):79-86.
17.	康辉, 贾连顺, 谭军, 等. 椎弓根螺钉固定或联合侧块螺钉固定治疗hangman骨折. 中国脊柱脊髓杂志, 2007, 17(10):757-760.
18.	Ma W, Xu R, Liu J, et al. Posterior short-segment fixation and fusion in unstable Hangman's fractures. Spine (Phila Pa 1976), 2011, 36(7):529-533.
19.	Hur H, Lee JK, Jang JW, et al. Is it feasible to treat unstable hangman's fracture via the primary standard anterior retropharyngeal approach? Eur Spine J, 2014, 23(8):1641-1647.
20.	Park JH, Kim SH, Cho KH. Clinical outcomes of posterior C2-C3 fixation for unstable Hangman's fracture compared with posterior C1-C3 fusion. Korean J Spine, 2014, 11(2):33-38.
21.	Jeong DH, You NK, Lee CK, et al. Posterior C2-C3 fixation for unstable Hangman's fracture. Korean J Spine, 2013, 10(3):165-169.
22.	Ying Z, Wen Y, Xinwei W, et al. Anterior cervical discectomy and fusion for unstable traumatic spondylolisthesis of the axis. Spine (Phila Pa 1976), 2008, 33(3):255-258.
23.	葛朝元, 郝定均, 贺宝荣, 等. 颈前路钢板内固定治疗不稳定Hangman骨折的疗效分析. 中国修复重建外科杂志, 2014, 28(6):728-732.
24.	王清, 王松, 钟德君, 等. 不稳定性Hangman骨折手术入路选择. 中国脊柱脊髓杂志, 2012, 22(6):526-530.
25.	Shin JJ, Kim SH, Cho YE, et al. Primary surgical management by reduction and fixation of unstable hangman's fractures with discoligamentous instability or combined fractures:clinical article. J Neurosurg Spine, 2013, 19(5):569-575.
26.	Muthukumar N. C1-C3 lateral mass fusion for type Ⅱa and type Ⅲ Hangman's fracture. J Craniovertebr Junction Spine, 2012, 3(2):62-66.
27.	Duggal N, Chamberlain RH, Perez-Garza LE, et al. Hangman's fracture:a biomechanical comparison of stabilization techniques. Spine (Phila Pa 1976), 2007, 32(2):182-187.
28.	Scheer JK, Tang JA, Smith JS, et al. Cervical spine alignment, sagittal deformity, and clinical implications:a review. J Neurosurg Spine, 2013, 19(2):141-159.
29.	吴向阳, 张喆, 吴健, 等. 上位颈椎前路手术咽后入路"窗口"显露技术的临床应用观察. 中国骨伤, 2009, 22(11):835-837.
30.	Park SH, Sung JK, Lee SH, et al. High anterior cervical approach to the upper cervical spine. Surg Neurol, 2007, 68(5):519-524.
31.	Skaf GS, Sabbagh AS, Hadi U. The advantages of submandibular gland resection in anterior retropharyngeal approach to the upper cervical spine. Eur Spine J, 2007, 16(4):469-477.
32.	Zhang Y, Zhang J, Wang X, et al. Application of the cervical subaxial anterior approach at C2 in select patients. Orthopedics, 2013, 36(5):e554-e560.
33.	黄阳亮, 刘少喻, 梁春祥, 等. 应用Solis融合器置入治疗Ⅱ型及Ⅱa型Hangman骨折的临床疗效. 中国脊柱脊髓杂志, 2012, 22(2):137-141.
34.	Behari S, Banerji D, Trivedi P, et al. Anterior retropharyngeal approach to the cervical spine. Neurol India, 2001, 49(4):342-349.
35.	黄阳亮, 刘少喻, 赵卫东, 等. Solis椎间融合器治疗Ⅱ型Hangman骨折的生物力学评价. 中国脊柱脊髓杂志, 2009, 19(4):285-289.
36.	陆声, 徐永清, 张元智, 等. 计算机辅助个体化导航模板在Hangman骨折中的临床应用. 中华创伤杂志, 2009, 25(10):886-889.
37.	Barbagallo GM, Romano D, Certo F, et al. Zero-P:a new zero-profile cage-plate device for single and multilevel ACDF. A single institution series with four years maximum follow-up and review of the literature on zero-profile devices. Eur Spine J, 2013, 22 Suppl 6:S868-878.

1. Effendi B, Roy D, Cornish B, et al. Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg (Br), 1981, 63-B(3):319-327.
2. Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg (Am), 1985, 67(2):217-226.
3. 蔡贤华, 陈庄洪, 黄继锋, 等. Hangman骨折损伤病理特点及颈前路钢板内固定治疗. 临床外科杂志, 2007, 15(5):349-351.
4. 谢宁, 倪斌, 陈德玉, 等. 第2、3颈椎前路融合联合第2颈椎椎弓根固定治疗不稳定Hangman骨折. 中华外科杂志, 2008, 46(4):267-269.
5. Xie N, Khoo LT, Yuan W, et al. Combined anterior C₂-C₃ fusion and C₂ pedicle screw fixation for the treatment of unstable hangman's fracture:a contrast to anterior approach only. Spine (Phila Pa 1976), 2010, 35(6):613-619.
6. 蔡贤华, 陈庄洪, 黄继锋, 等. 累及枢椎椎体的Hangman骨折七例报告. 中国骨与关节损伤杂志, 2009, 24(11):961-963.
7. Samaha C, Lazennec JY, Laporte C, et al. Hangman's fracture:the relationship between asymmetry and instability. J Bone Joint Surg (Br), 2000, 82(7):1046-1052.
8. 谢宁, 倪斌, 袁文, 等. 前路C2,3复位融合治疗Hangman骨折. 中华骨科杂志. 2008, 28(8):634-637.
9. Starr JK, Eismont FJ. Atypical hangman's fractures. Spine (Phila Pa 1976), 1993, 18(14):1954-1957.
10. 李浩淼, 刘少喻, 梁春祥, 等. 前路内固定治疗Ⅱ型及Ⅱa型Hangman骨折的疗效. 中国脊柱脊髓杂志, 2007, 17(2):107-110.
11. Zhang YS, Zhang JX, Yang QG, et al. Surgical management of the fractures of axis body:indications and surgical strategy. Eur Spine J, 2014, 23(8):1633-1640.
12. Yoshida G, Kanemura T, Ishikawa Y. Percutaneous pedicle screw fixation of a Hangman's fracture using intraoperative, full rotation, three-dimensional image (O-arm)-based navigation:a technical case report. Asian Spine J, 2012, 6(3):194-198.
13. 蔡贤华, 王威, 王志华, 等. 不同前路内固定方式治疗枢椎椎体横行骨折合并 Hangman 骨折稳定性的有限元分析. 中国脊柱脊髓杂志, 2014, 24(3):257-260.
14. 贾连顺, 李国. Hangman骨折. 中华骨科杂志, 2004, 24(5):317-320.
15. 贺瑞, 张文志, 尚希福, 等. 前路颌下血管神经间隙入路复位固定融合治疗Hangman骨折. 中国矫形外科杂志, 2012, 20(4):367-369.
16. Wu YS, Lin Y, Zhang XL, et al. Management of hangman's fracture with percutaneous transpedicular screw fixation. Eur Spine J, 2013, 22(1):79-86.
17. 康辉, 贾连顺, 谭军, 等. 椎弓根螺钉固定或联合侧块螺钉固定治疗hangman骨折. 中国脊柱脊髓杂志, 2007, 17(10):757-760.
18. Ma W, Xu R, Liu J, et al. Posterior short-segment fixation and fusion in unstable Hangman's fractures. Spine (Phila Pa 1976), 2011, 36(7):529-533.
19. Hur H, Lee JK, Jang JW, et al. Is it feasible to treat unstable hangman's fracture via the primary standard anterior retropharyngeal approach? Eur Spine J, 2014, 23(8):1641-1647.
20. Park JH, Kim SH, Cho KH. Clinical outcomes of posterior C2-C3 fixation for unstable Hangman's fracture compared with posterior C1-C3 fusion. Korean J Spine, 2014, 11(2):33-38.
21. Jeong DH, You NK, Lee CK, et al. Posterior C2-C3 fixation for unstable Hangman's fracture. Korean J Spine, 2013, 10(3):165-169.
22. Ying Z, Wen Y, Xinwei W, et al. Anterior cervical discectomy and fusion for unstable traumatic spondylolisthesis of the axis. Spine (Phila Pa 1976), 2008, 33(3):255-258.
23. 葛朝元, 郝定均, 贺宝荣, 等. 颈前路钢板内固定治疗不稳定Hangman骨折的疗效分析. 中国修复重建外科杂志, 2014, 28(6):728-732.
24. 王清, 王松, 钟德君, 等. 不稳定性Hangman骨折手术入路选择. 中国脊柱脊髓杂志, 2012, 22(6):526-530.
25. Shin JJ, Kim SH, Cho YE, et al. Primary surgical management by reduction and fixation of unstable hangman's fractures with discoligamentous instability or combined fractures:clinical article. J Neurosurg Spine, 2013, 19(5):569-575.
26. Muthukumar N. C1-C3 lateral mass fusion for type Ⅱa and type Ⅲ Hangman's fracture. J Craniovertebr Junction Spine, 2012, 3(2):62-66.
27. Duggal N, Chamberlain RH, Perez-Garza LE, et al. Hangman's fracture:a biomechanical comparison of stabilization techniques. Spine (Phila Pa 1976), 2007, 32(2):182-187.
28. Scheer JK, Tang JA, Smith JS, et al. Cervical spine alignment, sagittal deformity, and clinical implications:a review. J Neurosurg Spine, 2013, 19(2):141-159.
29. 吴向阳, 张喆, 吴健, 等. 上位颈椎前路手术咽后入路"窗口"显露技术的临床应用观察. 中国骨伤, 2009, 22(11):835-837.
30. Park SH, Sung JK, Lee SH, et al. High anterior cervical approach to the upper cervical spine. Surg Neurol, 2007, 68(5):519-524.
31. Skaf GS, Sabbagh AS, Hadi U. The advantages of submandibular gland resection in anterior retropharyngeal approach to the upper cervical spine. Eur Spine J, 2007, 16(4):469-477.
32. Zhang Y, Zhang J, Wang X, et al. Application of the cervical subaxial anterior approach at C2 in select patients. Orthopedics, 2013, 36(5):e554-e560.
33. 黄阳亮, 刘少喻, 梁春祥, 等. 应用Solis融合器置入治疗Ⅱ型及Ⅱa型Hangman骨折的临床疗效. 中国脊柱脊髓杂志, 2012, 22(2):137-141.
34. Behari S, Banerji D, Trivedi P, et al. Anterior retropharyngeal approach to the cervical spine. Neurol India, 2001, 49(4):342-349.
35. 黄阳亮, 刘少喻, 赵卫东, 等. Solis椎间融合器治疗Ⅱ型Hangman骨折的生物力学评价. 中国脊柱脊髓杂志, 2009, 19(4):285-289.
36. 陆声, 徐永清, 张元智, 等. 计算机辅助个体化导航模板在Hangman骨折中的临床应用. 中华创伤杂志, 2009, 25(10):886-889.
37. Barbagallo GM, Romano D, Certo F, et al. Zero-P:a new zero-profile cage-plate device for single and multilevel ACDF. A single institution series with four years maximum follow-up and review of the literature on zero-profile devices. Eur Spine J, 2013, 22 Suppl 6:S868-878.

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RESEARCH PROGRESS OF DIAGNOSIS AND TREATMENT OF Hangman FRACTURE

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