ISM, CNRS, unité de chirurgie rachidienne, Aix-Marseille université, CHU de Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France.
Service de neurochirurgie C et chirurgie du rachis, université Claude-Bernard Lyon 1, hôpital P. Wertheimer, 59, boulevard Pinel, 69003 Lyon, France.
Orthop Traumatol Surg Res. 2019 Jun;105(4):703-707. doi: 10.1016/j.otsr.2019.03.009. Epub 2019 Apr 17.
Hangman's fractures account for 15% to 20% of all cervical spine fractures. The grading system developed by Effendi and modified by Levine and Edwards is generally used as the basis for management decisions. Nonetheless, the optimal management remains controversial. The objective of this study was to describe the treatments used in France in patients with hangman's fractures. The complications and healing rates were analysed according to the fracture type and treatment used.
Among patients with hangman's fracture, those with disc damage must be treated surgically.
A prospective, multi-centre, observational study was conducted under the aegis of the French Society for Spine Surgery (SociétéFrançaisedeChirurgieRachidienne, SFCR). Patients were included if they had computed tomography (CT) evidence of hangman's fracture. Follow-up data were collected prospectively. Fracture healing was assessed on CT scans obtained 3 and 12 months after the injury. The type of treatment and complications were recorded routinely.
We included 34 patients. The fracture type according to Effendi modified by Levine and Edwards was I in 68% of patients, II in 29% of patients, and III in a single patient (3%). The treatment was non-operative in 21 (62%) patients and surgical in 11 (32%). All 28 patients re-evaluated after 1 year had evidence of fracture healing. The remaining 6 patients were lost to follow-up.
Hangman's fracture is associated with low rates of mortality and neurological complications. Non-operative treatment is appropriate in Type I hangman's fracture, with a 100% healing rate in our study. Types II and III are characterised by damage to the ligaments and discs requiring either anterior C2-C3 fusion or posterior C1-C3 screw fixation.
III.
绞刑骨折占所有颈椎骨折的 15%至 20%。Effendi 提出的分级系统，经 Levine 和 Edwards 修改后，通常被用作管理决策的基础。尽管如此，最佳治疗方法仍存在争议。本研究的目的是描述法国治疗绞刑骨折患者的方法。根据骨折类型和治疗方法分析并发症和愈合率。
在绞刑骨折患者中，有椎间盘损伤的患者必须接受手术治疗。
在法国脊柱外科协会（SociétéFrançaisedeChirurgieRachidienne，SFCR）的支持下，进行了一项前瞻性、多中心、观察性研究。纳入标准为 CT 检查证实有绞刑骨折的患者。前瞻性收集随访数据。在损伤后 3 个月和 12 个月时，通过 CT 扫描评估骨折愈合情况。常规记录治疗方法和并发症。
共纳入 34 例患者。根据 Effendi 改良的 Levine 和 Edwards 分型，I 型骨折占 68%，II 型骨折占 29%，III 型骨折占 1 例（3%）。21 例（62%）患者接受非手术治疗，11 例（32%）患者接受手术治疗。1 年后所有 28 例患者均有骨折愈合的证据。其余 6 例患者失访。
绞刑骨折的死亡率和神经并发症发生率较低。在本研究中，I 型绞刑骨折采用非手术治疗效果良好，愈合率为 100%。II 型和 III 型骨折的特点是韧带和椎间盘损伤，需要行前路 C2-C3 融合或后路 C1-C3 螺钉固定。
III 级。
