A Meta-analysis Comparing The Efficacy And Safety Of Anterior And Posterior Surgery For Odontoid Fractures

Objective:The treatment on odontoid fractures generally adopt anterior odontoid screw internal fixation or posterior atlantoaxial screw rod fixation.However,there are still disputes concerning the choice of different surgical methods.The purpose of this study is to compare the efficacy(fracture healing,postoperative cervical rotation)and safety(operating time,intraoperative blood loss,and incidence of surgical complications)of these two surgical approaches based on the existing evidence.Methods:Based on computer database resources(Pub Med,Cochrane,EMbase,CNKI,Wanfang,and Weipu databases),the retrospective cohort research(on the efficacy of anterior and posterior surgical treatment of odontoid fractures)has been carried out.With the search time spanning from the creating time of database to June2020,the basic information and data of the included assays have been organized and summarized,with the help of the Review Manager5.3 software provided by the Cochrane Collaboration for statistical analysis.Results:A total of 13 articles were referred,including 737 cases of odontoid fractures patients(conservatively treated cases excluded),among which there are 320 cases in the anterior surgery group(dentate screw internal fixation)and 302 cases in the posterior approach group(atlantoaxial screw rod fixation).By sorting and summarizing 13 articles and analyzing with the help of Rev Man5.3 software,the anterior and posterior surgery groups are compared in terms of the operation time,intraoperative blood loss,fracture healing,surgical complications(pharyngeal discomfort,infection,cerebrospinal fluid leakage,subcutaneous hematoma,heart Failure,etc.)and the difference in the degree of rotation of the cervical spine after surgery.The results showed: 1.Anterior surgery time was significantly less than posterior surgery time,[MD=-49.53,95%CI(-72.48,-26.59),Z=4.23,P<0.05].2.The blood loss during the anterior approach is significantly lower than that of the posterior approach,[MD=-201.21,95%CI(-231.98,-170.45),Z=12.82,P<0.05].3.There is no significant difference in fracture healing rate between the anterior and posterior surgery groups,[RR=0.96,95%CI(0.92,1.00),Z=1.83,P=0.07>0.05].4.There is no significant difference in surgical complications between the anterior and posterior surgery groups,[RR=0.94,95%CI(0.62,1.43),Z=0.29,P=0.77>0.05].5.The postoperative rotation degree of the anterior surgery group was better than that of the posterior surgery group,[MD=41.40,95%CI(35.36,47.44),Z=13.43,P<0.05].Conclusion:Meta-analysis suggests that there is no significant difference between anterior odontoid screw internal fixation and posterior atlantoaxial screw rod fixation in fracture healing rate and postoperative complications.But anterior surgery has the advantages of shorter operative time,less intraoperative bleeding and less damage to the cervical spine movement function,which makes it a more ideal way to repair odontoid fractures.In the practice of clinical treatment,it is still necessary to select the more appropriate treatment according to patient’s condition.