Study On Selection Of Operation Types In Surgical Treatments For Odontoid Fracture

Objective: To investigate therapeutic effects and selection of different operation types for odontoid fractureMethod: Retrospectively analyze 48 cases of odontoid fracture received surgical treatment in our department during 2004 and 2009. 33 males and 15 females were included aged between 14 and 73 years old, 34.8 years old on average.According to Anderson—D'Alonzo grading, among them 33 had Type II fracture, 15 had minor type III fracture, 19 cases received hollow compression screw internal fixation done by anterior approach, 29 cases received posterior atlantoaxial pedicle screw-plate system internal fixation and bone graft Arthrodesis.Result :The above group of cases received a follow-up of 6-60 months with an average of 37.1 months. All achieved bony union without complications such as implants loosening,prolapsus or ruptures except one case who didn't get bony union six months later after received screw nail fixation done by anterior approach and four cases of drop-out. Preoperatively 18 cases were grouped into ASIA spinal injury grading E, 23 cases grading D, 7 cases grading C while postoperatively 29 cases were grouped into grading E, 19 cases grading D.Conclusion: The healing rate of odontoid process screw internal fixation done by anterior approach and the fusion rate of posterior atlantoaxial pedicle screw-plate system internal fixation and bone graft arthrodesis were both high and both produced satisfactory clinical outcomes. On one hand, the odontoid process screw internal fixation done by anterior approach should be preferred when it came to type II or superficial type III odontoid process fracture if it was fresh or if the fracture was old but not longer than 3 months, without dislocation and responding well to traction reduction . Besides, the fracture line of type II fracture had to be horizontal or extended from anterior superior to posterior inferior and the transverse ligament of atlas had to be intact. On the other hand, posterior atlantoaxial pedicle screw-plate system internal fixation should be recommended when it came to other situation of type II and type III odontoid process fractures.