Clinical Effect Of Atlantoaxial Unilateral Three-dimensional Internal Fixation And Fusion In The Treatment Of Odontoid Fractures

Objective:Compared with traditional atlantoaxial pedicle fixation and fusion techniques,the feasibility of atlantoaxial unilateral three-dimensional internal fixation(unilateral atlantal pedicle screw + contralateral axial lamina screw)fusion technique in the treatment of dentate process fractures was discussed and its clinical effect was evaluated.It provides a new idea for surgical treatment of dentate process fracture with variation of upper cervical vertebra.Methods:A retrospective analysis was performed on 43 patients who were treated with posterior cervical nailing and rod fixation for dentate process fractures in our department.Among them,16 cases of dentate process fracture with upper cervical spine variation treated by unilateral three-dimensional internal fixation and fusion were treated as the experimental group(unilateral group).Twenty-seven patients with odontoid fractures treated with posterior atlantoaxial pedicle fixation(bilateral atlantoaxial pedicle screw + bilateral axial pedicle screw)were treated as the control group(bilateral group).Another 30 cases of anterior denture cannulated screw internal fixation were counted and compared with partial data of the above 43 cases.The observation indexes were age,sex and atlantoaxial dislocation type.Intraoperative blood loss and operation time;ASIA grading,VAS score and NDI index were used before and at the last follow-up.At different time points before and after surgery,cervical X-ray and cervical CT were used to observe the bone graft fusion rate,dentate process healing rate,bone graft fusion time and dentate process fracture healing time.All the above data were compared between the unilateral group and the bilateral group.Age,sex,VAS,NDI index before and at the last follow-up were compared between the anterior 30 cases and the posterior 43 cases.Results:1.There were no statistically significant differences in age and gender between the unilateral group and the bilateral group,and no statistically significant differences in preoperative ASIA,VAS score and NDI index between the two groups.The data of the two groups were comparable.There were no significant differences in ASIA,VAS score and NDI between the two groups at the last follow-up.2.The fusion rates of the two groups were 100%,with no statistical difference.The fusion time of the unilateral group was compared with that of the bilateral group,P > 0.05.The healing rate of the unilateral group was 85.71%,and that of the bilateral group was88.89%,P > 0.05.The healing time of the unilateral group was P > 0.05 compared with that of the bilateral group.3.Blood loss in the unilateral group(91.88 49.56)ml,and in the bilateral group(208.89 140.75)ml,P < 0.05.The operative time was 105.63 24.14 min in the unilateral group and 166.04 45.93 min in the bilateral group,P < 0.05.4.In the comparison of bone graft fusion rates at different time points,the fusion rate of the unilateral group was lower than that of the bilateral group at the time point 3months after surgery,and the difference was statistically significant.There was no significant difference 6 months after surgery.5.Compared with the unilateral group,the final ASIA grading of patients with nerve injury was improved by 1-2 grades compared with the preoperative level;VAS score and NDI of the last follow-up were improved compared with those before surgery,and the differences were statistically significant.6.There were no statistically significant differences between the anterior group and the posterior group in age,gender,preoperative VAS and NDI indexes,which were comparable.In the comparison of VAS score in the last follow-up,P > was 0.05.The NDI index in the last follow-up was P < 0.05,and the difference was statistically significant.Conclusion:1.Through preoperative and postoperative control studies of unilateral group,unilateral group and bilateral group,it has been proved that atlantoaxial unilateral three-dimensional internal fixation and fusion technology can achieve satisfactory clinical effect in the treatment of dentate process fractures,which is similar to the clinical effect of traditional atlantoaxial bilateral pedicle screw technology.In conclusion,unilateral three-dimensional internal fixation fusion technology is safe,feasible and effective.2.Unilateral three-dimensional internal fixation and fusion technology provides anew idea for the surgical scheme of dentate process fracture combined with upper cervical spine variation.