Clinical Study On Anatomy And Symptomatic Study Of Anterior And Posterior Decompression And Fixation Of Atlantoaxial Dislocation

Objective: Clinical study of posterior approach for atlantoaxial dislocation.Methods: From January 2014 to December 2016,40 patients with atlantoaxial dislocation were selected from the Second Affiliated Hospital of Nanchang University and Jiujiang Hospital Affiliated to Nanchang University.The patients were divided into group A and group B according to the different surgical methods.(Group A was treated with occipitocervical fusion and group B was treated with C1-2 fixation and internal fixation.)Preoperative imaging examinations showed that 40 patients had varying degrees of atlantoaxial dislocation,15 cases with syringomyelia,13 patients with Arnold-Chiari malformation and syringomyelia formation,12 cases with C2,C3 fusion,preoperative cervical MRI examination showed that all cases were spinal cord compression,preoperative JOA score of 8.3 ± 1.5 points.Patients were treated with occipitocervical fusion(posterior occipital-intervertebral screw fixation and internal fixation)and C1-2 fixation and internal fixation(atlas pedicle screw fixation).All patients were examined X-ray,cervical three-dimensional,CT to see the surgical results and the location of the screw,and JOA score,evaluation of surgical results.And provide anatomical basis for clinical occipital cervical fusion and atlantoaxial pedicle screw fixation.The clinical application results were evaluated and analyzed.Results: All operations were safely completed,intraoperative spinal cord and vertebral artery injury and other serious complications.The average time of about 3.8hours(3 to 6 hours),the average bleeding of about 260ml(200 ~ 500ml).All patients had significantly improved symptoms compared with preoperative,JOA score on the first day after surgery on average 12.2 ± 1.5 points,significantly improved compared with preoperative(p <0.05).Postoperative review of X-ray,cervical CT showed: 40 patients with atlantoaxial dislocation were significantly improved,MRI showed most of the cervical spinal cord compression was lifted.All patients were followed up for 2 to 25 months.The average follow-up was 14.1 ± 3.7 months.The average follow-up was 14.8 ± 2.1 points,which was improved(p <0.05).Duringthe follow-up period,there was no case of internal fixation loosening.Conclusion: Atlantoaxial dislocation posterior fixation(neck and occipital fusion and C1-2 nail bar reduction and internal fixation technology)in clinical application can improve the quality of life of patients,improve cervical function,the exact effect,safe and reliable,worthy of promotion and application.