Clinical Contrast Of C1Lateral Mass Screw And C2Pedical Screw Fixation Assisted By C-arm Fluoroscopy Or3D Navigation System

ObjectiveTo investigate the computer navigation-assisted posterior atlas lateral mass screws combined with pedicle screw for the treatment of traumatic atlantoaxial instability in the clinical application of the atlas lateral mass screws implanted in hand with the same period under the watchful eye of traditional X-ray combined with pedicle screw fixation of traumatic atlantoaxial instability were compared to determine the principles of treatment and clinical value of the computer navigation technology treatment of traumatic atlantoaxial instability.MethodsFrom October2009to June2011, the use of computer navigation-assisted posterior atlas lateral mass screws combined with pedicle screw fixation of traumatic atlantoaxial instability in26patients (Navigation group) with the same period in the traditional X ray monitoring hand implantation of the atlas lateral mass screws combined with pedicle screw for the treatment of traumatic atlantoaxial instability in21cases (unarmed group) to compare the two groups were recorded operative time, blood loss, intraoperative X-ray perspective the number of screws to reset the rate, postoperative complications, hospital fees, etc., and through Richte:classification criteria, the evaluation of pedicle screw position, three-dimensional CT evaluation of interbody fusion, record and compare the preoperative, postoperative JOA score and The Hirabayashi and other ways to calculate the rate of improvement.ResultsNavigation group implanted in the atlas lateral mass screws and pedicle screw52, which the initial planting success of101, and reset the screw3(2.8%) of the reset rate; unarmed group were implanted atlas lateral mass screws and pedicle screw42, the initial planting success of74, and reset the screw10(11.9%) of the reset rate, two sets of screws to reset the rates were significantly different (X=6.817, P=0.007). In operative time, blood loss, intraoperative X-ray fluoroscopy number of hospital costs navigation group and unarmed groups have more significant difference (P<0.05), the navigation group compared with the unarmed group, shorter operative time, intraoperative less bleeding, fewer intraoperative X-ray, but the increased cost of hospitalization was statistically significant (P<0.05). The rate of improvement in symptoms and postoperative complications, the difference was not statistically significant (P>0.05). Evaluation of pedicle screw position Richte:classification criteria, the navigation group Ⅰ grade screws50(96.2%); Ⅱ screws, two (3.8%), to penetrate the pedicle cortex about1mm, but no injuries to the spinal cord and vertebral arteries; does not appear Ⅲ level screw. All cases not found in the spinal cord, vertebral artery, spinal nerve damage. Screw of the unarmed group Ⅰ level of68(80.9%); Ⅱ screw16(19.1%), to penetrate the pedicle cortex about1mm, but no injuries to the spinal cord and vertebral arteries; does not appear Ⅲ level screw. Data discrepancies between the two was also significant (X=7.545, P=0.021). Navigation group52of the atlas lateral mass screw position is accurate, no violation of the intervertebral foramen, transverse foramen and articular process phenomenon. The unarmed group of42of the atlas lateral mass screw39is accurate, no violation of the intervertebral foramen, transverse foramen and articular processes of the phenomenon, three violations of atlas inferior articular process. All cases not found in the spinal cord, vertebral artery, spinal nerve damage. Data discrepancies between the two was also significant (X=7.545, P=0.021). Navigation group of unarmed group after a mean follow-up time, respectively (8.2+1.5) months and (7.9+1.5) months. After six months of three-dimensional CT showed the navigation group and unarmed group healed fracture of odontoid process, all posterior bone graft fusion without internal fixation loosening, displacement, fracture.ConclusionThe computer navigation-assisted posterior atlas lateral mass screws with pedicle screw for the treatment of traumatic atlantoaxial instability. Can greatly improve the development of accuracy and safety, lower the screw to reset the rate and reach of each screw biomechanical stability, while reducing the number of X-ray surgical exposure time, blood loss and intraoperative traumatic atlantoaxial instability in patients with cervical posterior atlantoaxial fusion provides a simple and efficient surgical aids. Expensive navigation equipment, to some extent, an increase of hospital costs.