Analysis Of The Curative Effect Of Anterior Approach Surgery At High Altitude On Cervical Fracture And Dislocation(AO Type C)

Objective To investigate the effect of simple anterior approach surgery on patients with cervical fracture and dislocation(AO type C)in the highland regions.Methods A follow-up study was conducted on the patients treated by anterior cervical approach surgery for FDCS from January 1,2015 to May31,2019.All case information was collected,including:gender,age,cause of injury,time from injury to surgery,length of stay,imaging diagnosis of lesion segment and AO typing;the sagittal diameter of cervical spinal canal was used to determine the Spinal Cord Injury(SCI)of FDCS patients according to the grading of American Spinal Injury Association(ASIA),Visual Analog Scale(VAS)score was used for pain assessment,the modified Japanese Orthopaedic Association(JOA)score was used for the determination of cervical Spinal Cord function,the type of fracture was classified using the AO classification,the neurological level of Spinal Cord Injury(SCI)was determined using the American Spinal Injury Association(ASIA)Impairment Classification,Preoperative and postoperative data of the above indicators were recorded(1 week,3months,6 months and 12 months),the differences in the studied parameters before and after surgery was performed with SPSS(version25.0.Results A total of 267 patients were treated,among whom 123 received surgical treatment,87 received anterior surgical treatment,62 patients with ao-c type cervical spine fractures and dislocation and received reduction by anterior cervical surgery,and 52 patients who finally met the one-year follow-up.In this study,40 males and 12 females were aged from 24 to 62 years old,with an average age of 43.58�1.56 years old.They generally received surgical treatment within 3 to 14 days after injury,with an average of 8.19�0.42 days.Causes of injury:30 cases of traffic injuries,15 cases of fall injuries,and 7 cases of foreign body injuries.The AO classification of all patients,specific subtype C:17 cases of type C1;23 cases of type C2;12 cases of type C3.Among the 52 patients who underwent open reduction and fixation via anterior cervical approach,18 cases were combined with articular process strangulation,13 cases were unilateral and 5 cases were bilateral.The relative displacement of most dislocated vertebral bodies is more than 50%.All the 52 patients underwent lesion clearance through the left anterolateral cervical approach incision with skin lines under general anesthesia,complete decompression was achieved as far as possible,reduction was achieved,and the purpose of cervical spine sequence restoration and reconstruction stability was achieved,the incision was removed on time to achieve primary healing.Comparison of effectiveness: the average recovery rate of encroachment ratio of vertebral canal cross section after dislocated segment is more than 60% compared with that before.?After anteriorcervical approach intervertebral disc resection and fusion treatment,38 cases were treated with anterior cervical approach intervertebral disc resection and fusion,and 14 cases were treated with anterior cervical approach subtotal vertebral body resection and bone grafting.After one year,the bone fusion rate was 92.31%.No nail plate loosening was found,the position was good,the titanium mesh was not sunken,and there was no refracture or false joint formation.?The sensory planes of all the patients were recovered from 2 to 4 planes one week after the operation,and the recovery of 3 to 10 planes(mean 6.5)was achieved in the patients followed up for more than half a year.The recovery of muscle strength was increased by at least one grade,and the ASIA grade ranged from 1 to 3,The improvement rates of JOA and VAS were statistically significant(P <0.001).?More than 90% of patients can achieve better long-term stability.Conclusion FDCS is feasible and effective through anterior approach.It has the following characteristics:1.The dislocated vertebral body can be reduced under direct vision,and there is no obvious reinjury caused by the reduction of the cervical spinal cord due to the damaged intervertebral disc and fracture pieces;simple and effective reset;can restore stability.2.reduced bleeding and simplified surgical procedures.3.reduced resource consumption,reduced family and social burden.