Clinical study on atlantoaxial pedicel screw and crosslink compression for atlantoaxial fracture

English Keywords:Atlantoaxial joint  Atlas fracture  Atlantoaxial instability  Internal fixation of fracture

English Abstract:

  【Abstract】 Objectives: To investigate the clinical effect of atlantoaxial vertebral pedicle screw and crosslink compression internal fixation in the treatment of atlas fracture and atlanto-axial instability. Methods: 14 patients with atlas fracture and atlantoaxial instability in our hospital from August 2013 to August 2017 were selected. There were 9 males and 5 females with an average age 43.1±1.2 years old (range, 22 to 59). All patients had a clear history of neck trauma, including traffic injury in 8 cases, high falling injury in 5 cases and head injury in 1 case. All patients with clinical manifestations, such as different degrees of back pain, neck stiffness, flexion and rotation restricted movement, in which 6 patients had different level of spinal damage such as limb numbness and weakness. All patients had preoperative imaging examination, such as X-ray, CT, three-dimensional reconstruction and MRI, skull traction also was carried out in all patients. Atlantoaxial vertebral pedicle screw and crosslink compression was performed under general anesthesia. Posterior atlantoaxial pedicle screw combined with transverse compression embracing internal fixation were performed under general anesthesia. The operation time, bleeding volume and complications were recorded, JOA score was used to evaluate the neurological function of the patients before and at 1 year after operation. Periodic review was conducted within 1 week, 3 months, 6 months and more than 1 year after operation to understand the internal fixation and fracture healing. Results: All cases got adequate fracture reduction without the damage of vertrbral artery, spinal cord and nerve root. Bleeding occurred in 1 case because of venous plexus injury and was staunched by gauze tamponade hemostasis, no symptoms of cerebral ischemia occurred. The operation time was 80-140 minutes, with an average of 120.3±10.5 minutes, and the bleeding volume was 150-310 ml, with an average of 180.5±30.5 ml. The JOA score was improved from preoperative (7.3±0.5)/(5-11) points to (14.4±0.3)/(13-17) points at one year after operation. The average improvement was (86.5±0.9)%/(76.5%-93.4%). Atlantoaxial vertebral graft got bony fusion in 3-6 months after operation, and all fractures were healed before the final follow-up without any occurrence of internal fixation loosening, broken screw or broken rod. Conclusions: The atlantoaxial vertebral pedicle screw and crosslink compression for treating atlas fracture and atlantoaxial instability has the following advantages: complete reduction of fracture and fixed firmly. It is an effective method for the treatment of atlantoaxial fracture combined with atlantoaxial instability.