Posterior atlantoaxial pedicle screws fixation combined C1/2 fusionin adultunstable atlas fracture

English Keywords:Atlas fractures  Transverse atlantal ligament  Atlantoaxial instability  C1/2 fusion

English Abstract:

  【Abstract】 Objectives: To investigate the clinical outcomes of posterior atlantoaxial pedicle screws fixation combined C1/2 fusion in adult unstable atlas fracture. Methods: A retrospective study was carried out on 27 patients with unstable atlas fracture who were admitted to our hospital from January 2014 to August 2018, including 7 females and 20 males, aging from 29 to 78 years(54.1±10.8years). The integrity of the transverse atlantal ligament(TAL) was used as a stability standard. Of the 27 patients, 16 patients were of simple atlas fracture, 10 patients were of atlas fractures with odontoid fractures, and 1 patient was of atlas fracture with Hangman fracture. 20 patients were injured by falling, 6 by car accidents, and 1 by bruise. All the patients were operated with posterior atlantoaxial pedicle screws fixation combined C1/2 fusion. The preoperative and postoperative clinical data and imaging data were recorded, and the preoperative and postoperative neck pain visual analogue scores(VAS), Japanese Orthopedic Association(JOA) scores. Bone fusion, internal fixation failure and wound infection were observed in the follow-up. Results: All the patients had successful operation. The operation time was 89-125min(103.7±9.3min), and the intraoperative blood loss was 90-180ml(135.6±24.2ml). No vertebral artery injury, spinal cord injury, or cerebrospinal fluid leakage occurred. All patients were followed up for 12-30 months(21.63±4.64 months). During the follow-up, there was no internal fixation failure, or wound infection. Bone fusion was completed in all the patients. The VAS scores of neck pain were 6.70±0.70 before surgery, and decreased to 1.59±0.61 at three months after surgery(P<0.05). The JOA scores were 10.85±1.11 before surgery and increased to 15.96±0.84 at three months after surgery(P<0.05). Conclusions: Posterior atlantoaxial pedicle screws fixation combined C1/2 fusion has clinical outcomes in adult unstable atlas fracture.