後方および前方より一期的に固定術を行った hangman's fracture の 1 例

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A bilateral pedicular fracture of the axis (hangman's fracture) is regarded as stable and can be treated with a collar or a halo vest. Surgical stabilization is only rarely needed in patients with significant displacement of the axis or chronic instability. We report on a patient with unstable hangman's fracture, for whom posterior and anterior fixation were performed in one stage. To the best of our knowledge, this is the first such reported case in the literature. A 74-year-old female was hit by a car on Jun. 12, 1999 and admitted to our hospital due to fractures of her lower limbs. The patient was neurologically normal. When she sat on a bed after treatment of her leg fractures, she complained of severe neck pain. Radiograph of the cervical spine showed fracture of the neural arch of the axis with dislocation of C2 on C3 due to locked facet (Levine type III) and a compression fracture of the C3 vertebral body. CT showed a bilateral interarticular fracture involving the body of the axis and facet dislocation. Reduction was not achieved by the use of 6 kg of skeletal traction, so the patient underwent surgery. She was placed prone and 3kg of skeletal traction was maintained during surgery. Following reduction of the dislocation by drilling of the superior facet of C3, posterior transpedicular fixation at the level of C2 was performed with pedicle screws combined with C2-C3 inter-spinous process wiring. Following posterior fixation, anterior discectomy of C2-C3 and bone grafting was performed in one stage. After surgery the patient's neck pain had disappeared, and was allowed to walk with neck collar day following her surgery. Our experience indicates that anterior fixation added to posterior fixation is a suitable treatment for aged patients with a complex hangman's fracture who are not successfully managed non-operatively.
日本脊髄外科学会の論文
2003-07-31

後方および前方より一期的に固定術を行った hangman's fracture の 1 例

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