| Objective:To design and develop a new type of distracting clamp for atlantoaxial dislocation in operation,evaluate the use value and preliminarily explore the application effect of the new type of distracting clamp by observing the use condition in operation and comparably analyzing the improvement of postoperative symptoms,postoperative imaging changes and long-term follow-up of patients.Methods:According to the inclusion criteria,collected and screened out 53 patients with atlantoaxial dislocation who were treated in the spinal subspecialty group of neurosurgery in Guizhou People's Hospital from February 2016 to June 2019.Included 23 patients with atlantoaxial dislocation who were treated with traditional distracting clamp from February2016 to August 2017 in the control group,and included 30 patients with atlantoaxial dislocation who were treated with new type of distracting clamp from September 2017 to June 2019 in the experimental group.53 patients were all diagnosed as atlantoaxial dislocation(reversible)before operation,for those patients with atlantoaxial dislocation that were difficult to be diagnosed,using dynamic CT image to clearly diagnose and classify,the operation methods were posterior fossa decompression + irreducible atlantoaxial dislocation intraoperative distraction reduction and internal fixation + bone graft fusion,and the operation was completed by the same operator.Through the intraoperative observation of the new type of distracting clamp use in the experimental group,and the comparative analysis of the ADI value before and after the operation,the recovery condition of neurological function symptom and the results of imaging reexamination,evaluated the preliminary use effect of the new type distracting clamp,and further evaluated the use effect of the new type distracting clamp through the comparative analysis between experimental group and control group.The recovery degree of neurological function symptom was appraised by JOA scoring method,including thepreoperative and postoperative change value and improvement rate of JOA scoring,the calculation formula of JOA scoring improvement rate was(postoperative-preoperative)/(17-preoperative)* 100%,the improvement rate > 60.00% is significant,25.00%-60.00% is effective,and < 25.00% is invalid.Using SPSS 20.0 to analyze the experimental data,the quantitative data was expressed by mean and standard deviation,the group comparison of quantitative data was performed by independent sample t test,and the comparison of matched design data was performed by paired design t test,the test level was ? = 0.05,when p < 0.05,it was considered the difference was statistically significant.Results:(1)There was no slipping of the distracting clamp in the operation of 30 patients who used the new type of distracting clamp to complete the distraction reduction.After short-term follow-up,it was found that the neurological symptoms of all patients were significantly improved,the atlanto odontoid distance after operation was reduced from an average of(6.31 ± 0.89)mm to(2.74 ± 0.91)mm,there was no one patient underwent a secondary operation.The JOA score of 30 patients is based on the improvement degree of neurological symptoms at the last follow-up,which was improved from preoperative(12.67 ± 2.70)to postoperative(15.80 ± 1.06),the average improvement rate was 69.05%,among them,23 cases were markedly effective,7 cases were effective and 0 cases were invalid.The improvement value of ADI,preoperative and postoperative changes of JOA score,improvement rate of JOA score were statistically significant(P < 0.001)by statistical analysis.(2)There was 2 slipping of the distracting clamp in the operation of 23 patients who used the traditional distracting clamp to complete the distraction reduction,the atlanto odontoid distance after operation was reduced from an average of(6.51 ± 1.11)mm to(3.21 ± 0.77)mm.The JOA score of 23 patients is based on the improvement degree of neurological function symptoms at the last follow-up,which was improved from preoperative(11.87 ± 2.22)to postoperative(15.22 ± 0.85),the average improvement rate was 66.67%,among them,16 cases were markedly effective,7 cases were effective and 0cases were invalid.The improvement value of ADI,preoperative and postoperative changes of JOA score,improvement rate of JOA score were statistically significant(P <0.001)by statistical analysis.(3)The ADI value of patients who used traditional distracting clamp to complete distraction reduction was 3.30 ± 1.30 mm,while the ADI value of patients who completed the distraction reduction with the new type of distracting clamp was 3.57 ± 1.15 mm,t =-0.810,P = 0.422(P > 0.05),there was no significant difference between the two groups.The JOA score of the patients who completed the distraction reduction with the traditional distracting clamp improved 3.35 ± 1.50 points,and the JOA score of the patients who completed the distraction reduction with the new type of distracting clamp improved 3.13± 1.92 points,t = 0.442,P = 0.661(P > 0.05),there was no significant difference.The improvement rate of postoperative symptoms was 66.67%(60.00,66.67)in patients who completed the distraction reduction with traditional distracting clamp,while the improvement rate of postoperative symptoms was 69.05%(65.00,100.00)in patients who completed the distraction reduction with new type of distracting clamp,z =-1.753,P =0.080(P > 0.05),there was no significant difference.Conclusion:The preliminary clinical effect of the new type of distracting clamp is satisfactory,and it has certain clinical value,the advantage of the new type distracting clamp is that it can not only effectively avoid the slipping of the distracting clamp during the operation,but also can safely and effectively complete the distraction reduction,so that the dislocated atlantoaxial joint can achieve or approach the complete reduction as much as possible. |
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