Clinical Efficacy For Conservative Treatments Of Atlas Fractures

Objective:To explore the indications and advantages of atlas fractures treated conservatively through retrospective study on the clinical efficacy of the fracture, including the fracture reduction, fracture union, short-term function and long-term function.Methods:The clinical information(including medical record, imagine material and follow-up data) of the patients who were suffered from the atlas fractures treated conservatively from January2006to December2012in Orthopedics of Wuhan General Hospital of Guangzhou Command was sorted and analyzed through the electronic medical records system and PACS system. The study objects were selected based on inclusion criteria, exclusion criteria. According to the types and characteristics of the fractures, every subject who has been selected would be put hyper-extended skull traction, whose kilogram based on the weight of different subjects. In the process of skull traction, regularly X-rays would be took beside the subject to confirm the reduction of the fracture. Besides, daily neurological examination would be recorded in order to understand whether secondary spinal cord injury happen or not. Head-neck-chest plaster would be implement after skull traction. In order to observe the healing situation of the fracture, monthly cervical multiple spiral CT scan and three-dimensional reconstruction was needed. On average of10weeks Head-neck-chest plaster would be removed when confirmed callus growth, fracture lines blur, the signs and symptoms of subjects with neck pain disappeared. And subject would be directed to move which the scope of cervical activities with no obvious discomfort. Then replace for Philadelphia collar external fixation for about two weeks, in which the daily wearing time would be gradually reduced while the upper cervical spine rotation activities would be increased gradually until clinical union. X-ray photo including hyper-extended and hyper-flexion of the cervical would be took to investigate the stability of the upper cervical spine. Measuring and recording the scope of cervical activities, as well as directing the subject to continue positive functional exercise of the upper cervical spine. According to the following-up plan draw up in the research, the contents such as the symptoms, signs, imaging data, and the scope of cervical activities were regularly collected. According to every follow-up stage, the situation of union was evaluated through the X-ray and CT images while the function of the cervical was evaluated by the scope of cervical activities. All the data have been gotten were analyzed by SPSS13.0software.Results:There were39cases with atlas fracture admitted to the department from January2006to December2012. According to the inclusion and exclusion criteria,35cases were selected, among them, there were8cases of no significant shift Jefferson’s fractures,10cases of lateral mass fractures,6cases of anterior arch fractures,7cases of anterior combined lateral mass fractures, 4cases of posterior arch fractures. But the actual cases in the research were28for7cases of them fall off. All of the cases were treated conservatively. Among them, there were6cases of no significant shift Jefferson’s fractures,9cases of lateral mass fractures,3cases of anterior arch fractures,7cases of anterior combined lateral mass fractures,3cases of posterior arch fractures. Four cases had numbness in the limbs and varying degrees of limbs weakness, According to the grades of ASIA, there was1case of grade C,3cases of grade D.28cases were followed-up for an average of18months (range12-24months). The follow-up rate is80%. At follow-up, the fractures of28cases healed with solid union. Solid union duration average4.2months (range3.5-6months). These28cases obtained atlantoaxial stability,and the range of motion of atlantoaxial returned to normal or near normal. Delayed-type injury of spinal cord and peripheral nerves were not founded. According to these patients’symptoms, signs and the recovery function of upper cervical spine:excellent in25, good in2, fair in1and poor in0, the fine rate was96.4%.Conclusion:The conservative treatments has the advantages of minimal invasion, simple procedure, no surgical risk and the function of atlantoaxial joint can be retained maximize. The indications of conservative treatments are as followed:no significant shift Jefferson’s fractures, lateral mass fractures, anterior arch fractures, anterior combined lateral mass fractures and posterior arch fractures, which the imagine material showed no spinal cord injury, the transverse ligament was fine and patients without signs and symptoms of spinal cord compression. The comminuted fracture unable to internal fixation and the patients require for conservative treatments should belonged to the indications. Atlas fractures can be satisfactorily treated with conservative methods based on the indications, reducing the time of head-neck-chest plaster immobilization appropriate and the positive functional exercise are a good guarantee for the recovery of the function of the upper cervical spine.