Efficacy Analysis Of Posterior Decompression Reduction And Internal Fixation For Atlantoaxial Dislocation In Children And Adolescents

Objective: According to the collected clinical data of patients with atlantoaxial dislocation in children and adolescents,we analyzed the curative effe ct of posterior decompression,reduction and internal fixation on these patients.Methods: From May 2011 to September 2017,17 patients with atlantoaxial disl ocation in children and adolescents treated in Neurosurgery Department,and retros pectively analyzed the clinical datas.There were 11 males and 6 females,aged 8-18 years(average 13.2 years).Preoperative imaging examination diagnosised as a tlantoaxial dislocation.All patients underwent posterior decompression,atlantoaxial dislocation in the reduction,internal fixation with occipitocervical and routine bone graft fusion.after surgery to assess improvement of clinical symptoms,spinal cor d compression,atlantoaxial dislocation in the reduction,the location of internal fix ation screw,bone fusion.Main evaluation index: JOA score,ADI,CMA changes.Measurement data to mean ± standard deviation,paired sample t test for statistical analy sis.Results: The patients were followed up for 3-36 months with an average of 28 months.(1)The postoperative clinical symptoms were relieved to varying degrees,JOA average score was significantly increased(12.88±1.83,15.06±1.35 after oper ation),the difference was statistically significant(P<0.05).(2)17 patients underg oing CT and MRI,atlantoaxial dislocation after operation were completely repaired in 15 cases and incompletely restored in 2 cases.The position of internal fixation screw was satisfactory and the fusion of bone graft was satisfactory.The spinalc ord compression relieved largely;the ADI was significantly reduced(preoperative ADI 8.85±1.96 mm,postoperative ADI 1.36±1.13mm),the difference was statisticall y significant(P<0.05);the CMA was significantly increased(Preoperative CMA 118.97±8.21 °,postoperative CMA 134.69±5.78°),the difference was statistically si gnificant(P<0.05),preoperative and postoperative contrast,the effect is better.(3)Postoperative complications: 1 patient with dyspnea,2 patients with occipital sub cutaneous effusion,without operative death or secondary neurological dysfunction.Conclusion: Posterior fossa decompression,atlantoaxial dislocation in the reset,occip itocervical fixation for children and adolescents atlantoaxial dislocation patients,shoud be based on imaging examination and 3D print model to choose personalized prog ram,so that it makes the lower risk of surgery.In addition,there was no significan t effect on the growth and development of cervical vertebra,comprehensive curati ve effect is good.It is a reasonable,safe and effective surgical method.