Clinical Observation Of Simple Anterior Approach Combined With Intraoperative Traction Reduction In The Treatment Of Lower Cervical Spine Fractures And Dislocations With Joint Interlocking

OBJECTIVE:To investigate the reduction method and feasibility of anterior approach combined with intraoperative traction reduction in the treatment of lower cervical fracture and dislocation combined with joint interlocking,and comparison of clinical efficacy with anterior and posterior combined surgery.METHODS:This study collected data on patients with lower cervical fracture and dislocation combined with joint interlocking treated by anterior and posterior combined surgery from July 2015 to April 2017 in the Department of Orthopaedics,The Second Affiliated Hospital of Nanchang University.And data through anterior approach combined with intraoperative traction reduction from May 2017 to February 2019.The operation was performed by the same surgeon,A total of 59 patients were included in this study.The 26 patients who underwent anterior-posterior combined surgery were referred to as the anterior-posterior combination group,and the 33 patients who underwent anterior approach combined with intraoperative traction reduction were referred to as the anterior group.Preoperative neurological JOA scores and Frankel classification,mean Cobb angle,intervertebral body slip distance,and intervertebral height were recorded during the hospitalization of the two groups of patients;Data of the average Cobb angle,intervertebral slip distance,and intervertebral height 3 days after operation;operation time,intraoperative blood loss,postoperative drainage,length of hospital stay,postoperative complications,etc.The average Cobb angle,intervertebral slip distance,intervertebral height,and JOA scores at 6 months after operation;The neurological function JOA scores and Frankel classification 12 months after operation,Postoperative JOA improvement rate were obtained through outpatient follow-up.SPSS 23.0 statistical software was used to statistically analyze the obtained data,and the difference was considered statistically significant at P <0.05.RESULTS:After analysis of the cases in the anterior-posterior combination group and the anterior group,There were no statistically significant differences in age,gender,time from injury to admission,time from admission to surgery,cause of trauma,condition of articular process interlocking,injury segment,and preoperative ASIA classification(P> 0.05).All 59 patients were successfully reset.Postoperative X-ray films showed that all patients had returned to normal sequence without spinal cord neurological deterioration.All cases had an outpatient follow-up record of more than 6 months,and the follow-up time was 12-36 months,with an average of 16.3 months;X-rays were reexamined 6 months after the operation.All patients had osseous fusion in the surgical segments,and the cervical curvature and intervertebral height were not lost again.Postoperative patients did not experience intervertebral cage or titanium mesh loss,titanium plate or screw loosening.Cervical spine stability.The operation time ?The number of days in hospital of the anterior approach group was shorter than that of the anterior and posterior combination group(P <0.05);the intraoperative blood loss?postoperative drainage?Hospital costs was less in the anterior approach group than the anterior and posterior combination group(P <0.05);Postoperative complications were less in the anterior group than that of the anterior and posterior combination group;the average Cobb angle,intervertebral body slip distance,intervertebral height,and Postoperative JOA improvement rate were slightly greater in the anterior and posterior combination group than that of the anterior group(P> 0.05);CONCLUSION:Patients who underwent anterior-posterior combined surgery and anterior approach combined with intraoperative traction reduction in the treatment of lower cervical fracture and dislocation combined with joint interlocking achieved satisfactory clinical outcomes.There was no significant difference in clinical efficacy between the two surgical approaches.Therefore,anterior approach combined with intraoperative traction reduction in the treatment of lower cervical fractures and dislocations with joint interlocking is a feasible and effective surgical solution in most cases.Compared with anterior and posterior combined surgery,it has the advantages of less surgical trauma,less bleeding,shorter operation time,Less postoperative complications and lower treatment cost.