Comparison Of The Efficacy Of Posterior Screw-plate System And Screw-rod System In Occipitocervical Fusion For The Treatment Of Upper Cervical Instability

Objective To investigate the clinical efficacy of posterior screw-plate system and screw-rod system in occipitocervical fusion for the treatment of upper cervical instability,and provide reference for the choice of internal fixation for posterior occipitocervical fusion.Methods From January 2010 to October 2017,Fifty-seven patients underwent occipitocervical fusion in our hospital due to upper cervical disease,including 31 males and 26 females,aged 12-72 years old,The average age is 48 years old.According to the surgical method,it was divided into the screw-plate system occipitocervical fusion group(A group,32 cases)and screw-rod system occipitocervical fusion group(B group,25 cases).By comparing the difference of operative time,intraoperative blood loss,complications,Japanese Orthopaedic Association(JOA)scores,Cervicomedullary Angle(CMA),atlantodens interval(ADI),pedicle screw misplacement rate,Occipital screw release rate,bone graft fusion,and loss of reduction rate between the two groups to assess the clinical efficacy of the patients.Statistical analysis was performed on the two groups of data.Results All patients were followed up for 6-27 months with an average of18 months.The operation time of group A was shorter than that of group B,and there was less blood loss in group A than in group B,there was a significant difference between the two groups(P<0.05);The Occipital screw release rate was 12.5% in group A and 4.0% in group B,There was no significant difference in the Occipital screw release rate in groups A and B(p<0.05).In The two groups,JOA scores,CMA,and ADI at postoperative 1 week and at the final follow-up were statistically significant different from those of pre-operation(P <0.05),there was no significant difference between the two groups at any time(P > 0.05).At the final follow-up,there was a slight loss of cervicomedullary angle in both groups,but there was no statistical difference compared with 1week after the operation(P > 0.05).At 1 week after operation,the anatomical reduction rates of A and B groups were 87.5% and 88.0% respectively,there was no significant difference between the two groups(P > 0.05).At the last follow-up,the loss rate of anatomical reduction was 6.3% and 4.0% for the A and B group,there was no significant difference between the two groups(P >0.05).In Group A,64 pedicle screws were placed,5 pedicle cortex were punctured,and the misplaced rate was 7.8%,one patient had vertebral artery injury,there was no other cerebral ischemic disease after the operation.In group B,50 pedicle screws were placed and 3 cortical bones were worn,the misplaced rate was 6.0%,there was no vertebral artery injury.There was no significant difference in the misplacement rate between the two groups(P<0.05).At the last follow-up,both patients in group A and B had bony fusion without any other serious complications.Conclusion The posterior occipitocervical fusion for the treatment of upper cervical spine instability with screw-plate system and screw-rod systemhas similar reduction effect and postoperative stability.Both can achieve satisfactory bone fusion and remission of neurological symptoms.For patients with osteoporosis and cervical flexion,screw-plate systems should be avoided,During the operation,excessive traction and excessive or insufficient pre-bending of the occipitocervical plate should be avoided,neck activity should be strictly limited after surgery to reduce the rate of occipital screw release.Both systems provide more internal fixation options for posterior occipitocervical fusion.