Gallows fracture or traumatic axial vertebral arch fracture
Introduction
Introduction to gallows fracture or traumatic vertebral arch fracture As early as the early 19th century, Wood-Jones (1913) described this type of fracture. By 1965, Schneider introduced it again and named it. The so-called Hangman fracture refers to the second occurrence. The fracture of the cervical spine isthmus is more common in the shackles, so it is also known as the gallows fracture. This kind of injury can be seen in the clinic and is regarded as ominous in the folk. Therefore, patients often have mental stress. basic knowledge The proportion of illness: 0.001% - 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: spinal cord injury
Cause
Causes of gallows fracture or traumatic vertebral arch fracture
(1) Causes of the disease
This fracture is often caused by neck-stretching violence.
(two) pathogenesis
The violent direction of this type of fracture is mostly from the mandible, which causes the cervical vertebrae to stretch. The skull can form a strong shear stress at the pedicle of the second cervical vertebrae by directly hitting the posterior arch of the first cervical vertebra and transmitting it to the posterior arch of the second cervical vertebra. When it exceeds the local bone load, it will cause the fracture. At this time, if the violent extension continues to act, it will cause the anterior longitudinal ligament of the 2~3 vertebral ganglia to break, and the anterior intervertebral space will be separated, resulting in the atlas. The compressive stress increases, and the fracture can occur (Fig. 1), which eventually causes high cervical spinal cord injury and affects the rapid death of the life center. This is the whole process of the sag, and of course, the suffocation and neck caused by the rope around the neck. Anorectal sinus reflex is another major cause of death. At present, this type of fracture is mainly seen in traffic accidents on the highway (neck overextension during sudden braking) and high diving accidents. The mechanism is different from that of the hangman. Yes: In the process of injury, in addition to the violence of the head and neck, the former is accompanied by compression violence behind the vertebral section; the latter is divided into violence.
Prevention
Prevention of gallows fracture or traumatic vertebral arch fracture
There is no effective preventive measure for this disease, and timely detection of timely diagnosis is the key to the prevention and treatment of this disease.
Complication
Complications of gallows fracture or traumatic vertebral arch fracture Complications spinal cord injury
Sometimes spinal cord injury can occur.
Symptom
Gallows fracture or traumatic vertebral arch fracture symptoms Common symptoms Swallowing disorders cervical spine fracture dislocation can not turn neck and neck separation ligament rupture
It is basically similar to the clinical manifestations of general cervical fracture and dislocation, including neck pain, tenderness, limited mobility, inconvenient swallowing, unstable head and neck, and support for both hands and neck, except for about 15% of cases with complete cervical spinal cord. Sexual (more common) or incomplete injury. Most cases have no symptoms of spinal cord stimulation or compression. From a clinical point of view, it is generally divided into stable and unstable according to the stability of the vertebral segment. The type I is stable, the type III is unstable, and the type II is usually a group of unstable ones except for a few ligaments.
Currently, gallows fractures are still typed using the method proposed by Levine and Edwards in 1985:
1. Type I (degree) is a bilateral pedicle fracture, the fracture line is located in front of the facet joint, mainly causing the second cervical vertebrae and the posterior articular process, the separation between the lamina and the spinous process, the distance between the two About 2mm (1~3mm), there is generally no pressure on the spinal cord tissue in the spinal canal, so there are few patients with spinal cord injury at the same time.
2. Type II (degrees) In order to further increase the violence on the basis of the former, not only the fracture is separated, but also accompanied by an angular deformity; the anterior longitudinal ligament or the posterior longitudinal ligament is broken, or both are fractured; The posterior margin of the body can be avulsed by the avulsion of the posterior longitudinal ligament, and the degree of separation of the fracture end is larger than the former, generally more than 3mm, or the angle is greater than 11°.
3. Type III (degree) is heavier than type II injury, not only the anterior longitudinal ligament and the posterior longitudinal ligament are fractured at the same time, and the degree of dislocation of the bilateral articular process fracture is more obvious, even showing dislocation of the vertebral joint. Associated with intervertebral disc and annulus fissure, and three lesions in the neck 2:
(1) pedicle or lamina fracture.
(2) Bilateral dislocation of the joint or dislocation.
(3) The anterior longitudinal ligament and the posterior longitudinal ligament are broken, resulting in subluxation or dislocation of the cervical 2 vertebral body.
Examine
Gallow fracture or traumatic vertebral arch fracture examination
A clear image can be obtained on the X-ray lateral position and the oblique position. If the fracture line is unclear and there is no displacement, the patient can be added with a slice or a CT slice. Cases with spinal neurological symptoms should be examined by MRI. The image shows that the fracture line is within 3mm and there is no angular deformation. Most of them are stable. If the fracture line exceeds 3mm and is deformed with forward or backward angle, it is unstable and severe. An angular deformity occurs.
Diagnosis
Diagnosis and diagnosis of gallows fracture or traumatic vertebral arch fracture
History of trauma
Mostly it is violence from the back of the jaw, and can be inferred from local skin rubs, contusions, etc.
2. Clinical manifestations
Mainly with neck symptoms, there is a sense of separation of the head and neck, patients like to hold the head by hand; it should be noted that about 15% of cases can have spinal symptoms.
3. Imaging examination
A clear image can be obtained on the X-ray lateral position and the oblique position. The common type shows that the fracture line is unclear and there is no shift. You can add a film or CT slice with spinal nerve symptoms.
The case should be performed by MRI. The image shows that the fracture line is within 3mm and there is no angular deformation. Most of them are stable. If the fracture line exceeds 3mm and is deformed with forward or backward angle, it is unstable. In severe cases, angular deformities can also occur at this time.
