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Abstract Objective To explore the operation strategy and the clinical effect of the treatment of bone grafting and fusion together with internal fixation by the Anterior-Cervical approach for Hangman type Ⅱand ⅡA fractures.Methods 16 cases of patients with Hangman fracture in our hospital from March 2010 to June 2016 were analyzed retrospectively.There were 12 cases of type Ⅱand 4 cases of type ⅡA according to the rule of Levine-Edwards.11 patients were male and 5 patients were female，aged from 23 to 56 years old with an average of 38.3 years old.The 12 patients with type Ⅱ fracture received the preoperative Skull-Traction-Reduction.The other 4 patients were only immobilized with the cervical gear.All the 16 patients underwen excision of C2～3 intervertebral disk by the anterior cervical approach and autogeneic ilium implantation or interbody fusion cage with Titanium plate internal fixation.2 of them received the decompressive resection of posterior longitudinal ligament.Results None of the 16 patients suffered from any complications like injuries in vessels，nerves or esophagus.The cervical pain was markedly alleviated. The preoperative VAS scoring was 6.1 points compared to the postoperative counterpart of 2.3 points.All the patients gained anatomic reattachment in the axis，which is confirmed by the X-ray examination.The locations of the internal fixation were good.There were no any loosening or rupture.The postoperative follow-up in 6 to 18 months revealed that all the cases had a bony fusion after the bone grafting at the cervical C2～3 level.Conclusion The treatment of bone grafting and fusion together with internal fixation by the AnteriorCervical approach is a good choice for Hangman type Ⅱ and ⅡA fractures because of the good reduction，firm fixation and the high rate of bony fusion of the bone grafting.Therefore，it is a safe，reliable and effective treatment.
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