The Value Of Rapid Oropharyngeal Reattachment Under General Anesthesia In The Treatment Of Acute Traumatic Atlantoaxial Dislocation In Adults

Objective:To investigate the value of rapid oropharyngeal reattachment under general anesthesia in the treatment of acute traumatic atlantoaxial dislocation in adults.Method:A retrospective analysis of 10 cases of adult patients with acute traumatic atlantoaxial dislocation combined with oropharyngeal rapid manual reduction combined with one-stage posterior fixation and bone graft fusion from January 2015 to August 2018,male 6 For example,4 females;age 42-81 years old(56.9±12.49 years old);course of disease 1 to 20 days(6.0±6.12 days);6 cases of fall injuries in high places,4 cases of car accident injuries;according to injury mechanism: odontoid fractures 8 For example,the transverse ligament was broken in2 cases.All cases had a history of trauma before surgery,which was characterized by neck pain with limited mobility and varying degrees of spinal cord injury.After general anesthesia,the somatosensory evoked potential(SEP)was monitored by the oropharyngeal rapid manual reset.After the manual reset,the C-arm machine was used to observe the reset condition through fluoroscopy.All of them were satisfactorily reset.After the successful reset,the posterior fixation was performed.Bone fusion.One patient with a history of ankylosing spondylitis underwent posterior C1~C4 fixed bone graft fusion,and the rest underwent posterior C1/2 fixed bone graft fusion.Follow-up observation of clinical symptoms,fracture or bone graft fusion rate,cervical vertebra activity and neurological recovery.Neurological improvement was assessed according to Frankel grading and Visual Analogue Scale/Score(VAS).Result:Ten patients underwent manual reduction under general anesthesia,and the manual reset procedure was smooth.There was no abnormality in SEP monitoring during the reset procedure.The success rate of reduction was 100%.After successful reduction,one-stage posterior fixation and bone graft fusion were performed.All cases were performed.All the operations were successfully completed,and nosignificant increase in postoperative neurological symptoms.One patient with ankylosing spondylitis died of acne infection control 2 months after discharge,and one patient was lost to follow-up.The other 8 patients were followed up for 6 to 30months(15.25±10.42 months).The Frankel grading and pain visual analogue scale VAS of spinal cord injury were improved in all cases at 1 week and at the last follow-up.At the last follow-up,the nail rod was well fixed,and no atlantoaxial instability and re-displacement were observed.The cervical vertebrae activity was43-55°(49.38±4.24°).At the last follow-up,6 patients were followed up with teeth.Patients with spur fractures: 2 cases of odontoid fractures did not heal,4 cases were healed;8 patients were followed up: 6 cases of posterior bone graft obtained bone fusion in 3 to 6 months,1 patient with transverse ligament injury At 6 months follow-up,posterior fusion of the posterior approach was performed,but the fixation of the nail was good.The follow-up observation was continued.One patient with type IIB odontoid fracture had bone resorption at the last follow-up,which was better in odontoid fracture.Healed well and no further treatment is required.Conclusion:Acute traumatic atlantoaxial dislocation in adults can achieve better reduction by rapid oropharyngeal reattachment under general anesthesia.After successful reduction,one-stage posterior fixation and bone graft fusion can achieve good therapeutic effect.