Review of surgical treatment of atlantoaxial dislocation in recent 20 years in Chinese

English Keywords:Atlantoaxial  Dislocation  Screw  Fixation  Literature analysis  China

English Abstract:

  【Abstract】 Objectives: To analyze the Chinese literatures of atlantoaxial dislocation in recent 20 years and optimize surgical approach for them. Methods: An online search of a total of 4 databases including CNKI from January 1993 to December 2012 using the key words "atlas", "axis", "atlantoaxial" and "surgical treatment" was performed; all references of literatures were also reviewed. The inclusive criteria included operative approaches, the literatures lack of detailed surgery and nursing articles were excluded. Statistical analysis index included: ①province distribution of literatures, ②origination and citation frequency of literature, ③annual amount of surgery for antlantoaxial dislocation, ④mortality and complications. Results: There were 363 out of 2929 literatures adopted in our study, most literatures came from the following provinces: Guangdong, Zhejiang, Hu′nan. The journals cited were: Chinese Journal of Spine and Spinal Cord, Chinese Journal of Bone and Joint Injury, Orthopedic Journal of China. The three most cited literatures were "Anatomic study of atlas by using screw fixation via posterior arch and lateral mass", "Primary report of lateral mass fixation between atlas and axis by using screw-plate system", "Anatomical measurement of atlas and axis and its clinical significance". The amount of surgeries was 7526, and from 1993 to 2000, this number was 544, the main operation managements were occipital-cervical fusion by using U-shape rod, Gallie technique and laminal clamp; from 2001 to 2006, the number was 2673, from 2007 to 2012, the number was 4309, and the main operation managements were atlas lateral mass screw technique, atlas transpedicle screw technique, occipital-cervical plate-screw technique or one-stage anterior release and posterior or anterior fixation for irreducible atlantoaxial dislocation. The main complications included: injury of venous plexus, screw displacement, injury of nerve, incision infection and bone nunfusion. There were 23 deaths in 7526 patients(0.31%). Conclusions: 10 years ago, Chinese main surgery for atlantoaxial dislocation is posterior non-screw fixation; while in recent 10 years, the main surgery is atlas transpedicle screw technique and atlas lateral mass screw technique, specially for irreducible atlantoaxial dislocation, which shows some improvements for atlantoaxial dislocation and original surgery in the world.