Murphy Hamadi, Schroeder Gregory D, Shi Weilong J, Kepler Christopher K, Kurd Mark F, Fleischman Andrew N, Kandziora Frank, Chapman Jens R, Benneker Lorin M, Vaccaro Alexander R
*Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA; †Center for Spine Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany; ‡Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA; and §Spine Unit, Department for Orthopaedics and Traumatology, Inselspital, University of Bern, Bern, Switzerland.
J Orthop Trauma. 2017 Sep;31 Suppl 4:S90-S95. doi: 10.1097/BOT.0000000000000952.
Traumatic spondylolisthesis of the axis, is a common cervical spine fracture; however, to date there is limited data available to guide the treatment of these injuries. The purpose of this review is to provide an evidence-based analysis of the literature and clinical outcomes associated with the surgical and nonsurgical management of hangman's fractures.
A systematic literature search was conducted using PubMed (MEDLINE) and Scopus (EMBASE, MEDLINE, COMPENDEX) for all articles describing the treatment of hangman's fractures in 2 or more patients. Risk of nonunion, mortality, complications, and treatment failure (defined as the need for surgery in the nonsurgically managed patients and the need for revision surgery for any reason in the surgically managed patients) was compared for operative and nonoperative treatment methods using a generalized linear mixed model and odds ratio analysis.
Overall, 25 studies met the inclusion criteria and were included in our quantitative analysis. Bony union was the principal outcome measure used to assess successful treatment. All studies included documented fracture union and were included in statistical analyses. The overall union rate for 131 fractures treated nonsurgically was 94.14% [95% confidence interval (CI), 76.15-98.78]. The overall union rate for 417 fractures treated surgically was 99.35% (95% CI, 96.81-99.87). Chance of nonunion was lower in those patients treated surgically (odds ratio, 0.12; 95% CI, 0.02-0.71). There was not a significant difference in mortality between patients treated surgically (0.16%; 95% CI, 0.01%-2.89%) and nonsurgically (1.04%; 95% CI, 0.08%-11.4%) (odds ratio, 0.15; 95% CI, 0.01-2.11). Treatment failure was less likely in the surgical treatment group (0.12%; 95% CI, 0.01%-2.45%) than the nonsurgical treatment group (0.71%; 95% CI, 0.28%-15.75%) (odds ratio 0.07; 95% CI, 0.01-0.56).
Hangman's fractures are common injuries, and surgical treatment leads to an increase in the rate of osteosynthesis/fusion without significantly increasing the rate of complication. Both an anterior and a posterior approach result in a high rate of fusion, and neither approach seems to be superior.
枢椎创伤性滑脱是一种常见的颈椎骨折；然而，迄今为止，可用于指导此类损伤治疗的数据有限。本综述的目的是对与绞刑者骨折手术和非手术治疗相关的文献及临床结果进行循证分析。
使用PubMed（医学索引数据库）和Scopus（工程索引数据库、医学索引数据库、科学技术会议录索引）进行系统的文献检索，查找所有描述2例或更多患者绞刑者骨折治疗情况的文章。采用广义线性混合模型和比值比分析，比较手术和非手术治疗方法的骨不连风险、死亡率、并发症及治疗失败率（非手术治疗患者定义为需要手术，手术治疗患者定义为因任何原因需要翻修手术）。
总体而言，25项研究符合纳入标准并纳入我们的定量分析。骨愈合是用于评估治疗成功的主要结果指标。所有研究均记录了骨折愈合情况并纳入统计分析。131例非手术治疗骨折的总体愈合率为94.14%[95%置信区间（CI），76.15 - 98.78]。417例手术治疗骨折的总体愈合率为99.35%（95%CI，96.81 - 99.87）。手术治疗患者的骨不连几率较低（比值比，0.12；95%CI，0.02 - 0.71）。手术治疗患者（0.16%；95%CI，0.01% - 2.89%）和非手术治疗患者（1.04%；95%CI，0.08% - 11.4%）的死亡率无显著差异（比值比，0.15；95%CI，0.01 - 2.11）。手术治疗组的治疗失败率（0.12%；95%CI，0.01% - 2.45%）低于非手术治疗组（0.71%；95%CI，0.28% - 15.75%）（比值比0.07；95%CI，0.01 - 0.56）。
绞刑者骨折是常见损伤，手术治疗可提高骨合成/融合率，且不显著增加并发症发生率。前路和后路手术均有较高的融合率，且两种方法似乎无明显优劣之分。
