Objective To evaluate the surgical management and result of C2 pedicle screw combined with C3 lateral mass screw fixation for treatment of instable Hangman's fracture. Methods From August 2005 to December 2010,16 patients with instable Hangman's fracture were all treated with C2 pedicle screw combined with C3 lateral mass screw fixation,which involved 11 males and 5 females with an average age of 35. 4 years old (range 19- 59). According to Levine-Edwards classification ,11 cases were type Ⅰ ,5 cases were type Ⅱ a,2 cases were type Ⅲ . All the patients complained neck pain and limitation of cervical movement. There were D spinal injury in 3 cases and E in 13 cases according to Frankel scale. Results All patients were followed up for a mean time of 13. 5 months (range 9~36 months). The operative time was 95~170 min (average 114 min) and the blood loss was 290~450 mL(average 353 mL). All fractures healed at 6 months postoperatively. There was no internal fixation fracture or loosing occurred. The cervical movement was excellent. Three cases of grade D spinal injury recovered to grade E. Conclusion C2 pedicle screw combined with C3 lateral mass screw fixation is an effective method for treatment of instable Hangman's fracture.%目的 探讨C2椎弓根螺钉联合C3侧块螺钉内固定治疗不稳定性Hangman骨折的临床效果及应用价值.方法 2005年8月至2010年12月采用后路C2椎弓根螺钉联合C3侧块螺钉内固定治疗16例不稳定性Hangman骨折患者,男11例,女5例;年龄19～59岁,平均35.4岁.骨折按Levine-Edwards分类,Ⅱ型9例,Ⅱa型5例,Ⅲ型2例.脊髓损伤按Frankel分级,D级3例,E级13例.结果 所有患者均获随访,随访时间9～36个月(平均18个月).手术时间95～170 min(平均114 min),术中出血290～450 mL(平均353mL),术后6个月复查时,骨折均愈合,无断钉、断棒及螺钉松动发生,颈部活动功能恢复良好.脊髓功能D级3例均恢复至E级.结论 经后路C2椎弓根螺钉联合C3侧块螺钉内固定是治疗Hangman骨折的良好手术方式.
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