The Short-term Clinical Observation Of Pedicle Posterior Screw Rod System In The Treatment Of Adult Traumatic Atlantoaxial Dislocation

Objective:To compare the curative effect of posterior pedicle screw fixation and Apofix operation in treatment of adult traumatic atlantoaxial dislocation, the optimal operation mode of adult traumatic atlantoaxial dislocation.Methods:In our hospital from2010June to2013June during the adult in61patients with traumatic atlantoaxial dislocation of the successful implementation of the operation, they were divided into group Apofix (control group) and pedicle screw group (observation group). The observation group methods:after successful anesthesia, prone position, the first ring fixation head. The posterior median approach, open exposure atlantoaxial posterior structure layer by layer. Select the insertion point into the atlas pedicle screw. In order to open cone bone cortex,2mm pedicle screw cone along the pedicle of cone penetration, Kirschner wire probe pin tract without any error,2.5mm pedicle screw cone expansion screw, screw in diameter of3.5mm pedicle screw; to open cone in the C2lateral mass internal taper on cortical bone, neural stripping and ion probe screw diameter,2.5hand taper along the axis pedicle screw on the edge bevel, Kirschner wire probe pin tract without error, screw in diameter of3.5mm pedicle screw. The mounting base and a connecting rod, tighten the nut fixed axis lifting rod, tighten the nut by reduction and fixation of atlas atlas. Bone graft bed, autologous iliac bone graft, drainage tube. The control group was treated with Apofix operation mode. Observation of perioperative parameters, two groups of patients with reset effect, stability, bone fusion rate and recovery of spinal cord function, efficacy and compared between the two groups.Results:(1) compared with the control group, the patients in observation group average short operation time, less bleeding, postoperative drainage, extubation time negative pressure drainage after operation, there was significant difference (P<0.05), the observation group wound healing time was13.43±0.98d,13.35±1.02d group and the control group. No significant differences. (2)6months after operation, the image comparison, the observation group and only1cases have atlantoaxial slightly forward, but there is no obvious anterior arch of atlas upward and atlantoaxial posterior spine clearance reduction, identified as not completely reset. While the control group had11cases, anterior arch of atlas atlas moved upward and atlantoaxial posterior interspinous space decreasing phenomenon, consider not completely reset. The observation group is not completely reset the incidence was significantly lower than the control, there was statistically significant difference (X2=6.48, P<0.05).(3) after6months of two groups were analyzed, the complication rate of observation group was6.45%, significantly lower than that of control group was26.67%, two groups had significant difference (X2=4.29, P<0.05).(4)6months after operation, two groups of patients with JOA scores were significantly higher than those before operation, there were significant differences (t=4.28,2.91, P<0.05); after6months of observation group the JOA score was significantly higher than the control group (t=3.26, P<0.05).(5) the clinical efficacy of Odom6months clinical efficacy were evaluated after operation. In observation group, the excellent and good rate was87.10%, significantly higher than the control group60%; total effective rate of observation group is100%, significantly higher than that of control group was93.33%, there was significant difference (X2=14.28,8.39, P<0.05).Conclusion:Posterior pedicle screw technique in the treatment of adult traumatic atlantoaxialdislocation has satisfactory clinical efficacy, operation mode is superior to APofix.