Clinical Analysis Of Surgical Treatment Of Odontoid Fractures

Purpose:To compare the clinical effects of three different surgical methods for odontoid process fracture were,the feasibility of posterior atlantoaxial non-fusion internal fixation was proved,and the surgical indications and selection of surgical methods for odontoid process fracture were discussed.Materials and methods:45 patients with odontoid process fracture admitted to our hospital from January 2014 to December 2019 were selected,including 35 males and 10 females.According to the mode of operation,the patients were divided into four groups: posterior atlantoaxial pedicle screw fixation group(posterior non-fusion group),posterior cervical fusion internal fixation group(posterior fusion group),anterior odontoid screw group(anterior group),according to operation time,blood loss,fracture healing,fracture fusion,cervical range of motion measurement(including flexion,extension,left and right rotation),Neck pain visual analogue scale score(VAS)as related evaluation indicators,through the statistical analysis of each parameter index to evaluate the clinical effect of each operation on odontoid process fracture.Result:1.The operation time: posterior non-fusion group:161.54 ±67.22 min,posterior fusion group: 266.94 ±93.80 min,anterior group: 123.21±13.67 min,anterior group was less than posterior fusion group,the difference was statistically significant,anterior group than posterior non-fusion group p > 0.05,the difference was not statistically significant,posterior non-fusion group was less than posterior fusion group,the difference was statistically significant.2.Surgical blood loss: posterior non-fusion group: 217.69 ±45.31 ml,posterior fusion group: 233.89 ±45.75 ml,anterior group: 117.50±10.86 ml,anterior group is smaller than posterior fusion group,the difference is statistically significant,anterior group is smaller than posterior non-fusion group,the difference is statistically significant,posterior non-fusion group than posterior fusion group,the difference is not statistically significant.3.Fracture healing and fusion: posterior non-fusion group: 3-6months,posterior fusion group: 3-6 months,anterior group: 4-6 months.In the posterior fusion group,all the bone grafts were fused at the last follow-up.No complications such as screw loosening,shedding and nail breaking occurred in 45 patients..4.Cervical range of motion(CROM): posterior non-fusion group before internal fixation(flexion: 11.72 ±1.28 degrees,extension: 30.85±4.01,left rotation: 28.194.18,right rotation: 28.31 ±3.03 degrees)after internal fixation(flexion: 27.19 ±3.29 degrees,extension: 49.42 ±6.38 degrees,left rotation: 46.81 ±3.61 degrees,right rotation: 45.73 ±4.23degrees).After the internal fixation was removed,the flexion and extension of the cervical spine and the degree of rotation between the left and right were significantly improved.The difference was statistically significant.In the posterior fusion group(flexion: 13.19±2.05 degrees,extension: 31.89 ±3.10 degrees,left rotation: 29.94 ±4.07 degrees,right rotation: 28.11 ±2.81 degrees),the posterior non-fusion secondary removal internal fixation group was significantly higher than the posterior fusion group(flexion: 13.19 ±2.05,extension: 31.89 ±3.10,left rotation: 29.94 ±4.07,right rotation: 28.11 ±2.81).5.VAS score: the scores of posterior non-fusion group,posterior fusion group,anterior group and anterior group were 6.62 ±0.87,2.15±0.90,6.67 ±0.91,2.00 ±0.69,6.07 ±0.73 and 1.36 ±0.74,respectively,and those of posterior fusion group,anterior group and anterior group were 6.62 ±0.87,2.15 ±0.90,6.67 ±0.91,2.00 ±0.69,6.07 ±0.73 and1.36 ±0.74 respectively.All groups were improved after operation,and the difference was statistically significant.Conclusion:1.Posterior atlantoaxial pedicle screw fixation,non-fusion Ⅱ-stage internal fixation,posterior cervical fusion(posterior occipital-cervical fusion,atlantoaxial fusion)and anterior odontoid process screw all can effectively treat odontoid process fracture.2.Posterior atlantoaxial pedicle screw fixation and non-fusion Ⅱ stage removal internal fixation is mainly suitable for ⅡC and superficial Ⅲ odontoid process fractures without transverse ligament injury,which can not be performed by anterior odontoid process screws,and can restore cervical range of motion after operation.3.Posterior fusion and fixation is suitable for comminuted type ⅡB odontoid process fracture with transverse ligament injury,atlantoaxial instability and unstable odontoid process type Ⅱ and type Ⅲ fracture which can not be reduced.4.Anterior odontoid process screw operation is mainly suitable for fresh type ⅡB odontoid process fracture without transverse ligament injury and stable fracture.A single screw can be used。...