Treatment Of Jefferson-3 Atlas Fractures With The Atlantoaxial Root Nail Transverse Compression Technique

Objective: To compare clinical efficacy of single-segment atlas pedicle screw with atlantoaxial lateral block screw fixation in the treatment of unstable atlantoaxial fracturesMethods: Retrospective analysis of 24 cases of unstable atlas fractures treated from January 2014 to January 2019 was conducted.Fourteen cases were treated with single-segment atlas pedicle screw internal fixation（single-segment group）and 10 cases with atlantoaxial lateral block screw internal fixation（multi-segment group）.The operative time,intraoperative bleeding,length of hospital stay,and pain VAS score,JOA score,LMD value,R-J line length,and ADI value at the last follow-up were compared between the 2 groups.Results: Both groups successfully completed the operation and obtained a complete follow-up.The follow-up time was 10-15 months,with an average of 12.6 months.All incisions healed in one stage,and all fractures healed at the last follow-up,with good functional recovery of the atlantoaxial joint.The operative time,intraoperative bleeding,and hospital stay in the single-segment group were less than those in the multi-segment group,and the difference was statistically significant（P<0.05）.The differences in pain VAS score,JOA score,LMD value,R-J line length,and ADI value between the 2 groups at the final follow-up were not statistically significant（P> 0.05）.Conclusion: Single-segment fixation of the atlas pedicle and lateral block screw fixation of atlantoaxial for unstable atlas fractures can achieve the same efficacy under certain conditions.For different atlas fractures,specific problems should be analyzed and the appropriate surgical approach should be carefully chosen.