Comparative study on the effect of single-segment fixation using transoral anterior JeRP and posterior horizontal screw-rod in the treatment of unstable atlas fracture

English Keywords:Atlas fracture  Unstable fracture  Transoral anterior approach  Posterior approach  Single-segment fixation  Clinical effect

English Abstract:

  【Abstract】 Objectives: To compare the clinical effects of single-segment fixations using transoral anterior JeRP and posterior horizontal screw-rod in the treatment of unstable atlas fractures. Methods: The clinical data of 33 patients with unstable atlas fractures treated with single-segment fixation in our hospital from June 2019 to June 2022 were retrospectively analyzed, including 21 males and 12 females, with an average age of 45.1±14.3 years. Among them, 22 patients were treated with transoral anterior JeRP fixation(JeRP group) and 11 patients were treated with posterior horizontal screw-rod fixation(PSR group). There was no statistical difference in age, gender, and course of disease between the two groups. The operative time, blood loss, length of hospital stay, and preoperative, before charge, and final follow-up visual analogue scale(VAS) score, neck disability index(NDI), distance of anterior arch fracture(DAAF) and distance of posterior arch fracture(DPAF), lateral mass displacement(LMD), R-J distance(the vertical distance from the midpoint of the lower margin of the axis to the McGregor line), postoperative complications, as well as fracture fusion rate 3 months and 6 months after surgery were compared between the two groups and analyzed statistically. Results: The operation was completed successfully in both groups without neurovascular injury or other complications. There was no difference in operative time between the two groups(P>0.05), but the blood loss in JeRP group was less than that in PSR group(P<0.05). The length of hospital stay in the PSR group was shorter than that in the JeRP group(P<0.05). There were no statistically significant differences in preoperative VAS score, NDI, DAAF, DPAF, LMD and R-J distance between the two groups(P>0.05). The VAS scores of the JeRP group before and after operation, and at final follow-up were 5.6±1.0, 0.9±0.8 and 0.5±0.5, respectively, while the VAS scores of the PSR group were 5.1±0.9, 0.8±0.9 and 0.4±0.5, respectively. The VAS scores after operation and at final follow-up of both groups were significantly lower than those before operation(P<0.05), and there was no difference between the two groups(P<0.05). The preoperative, postoperative and final follow-up NDI of the JeRP group were (58.5±3.5)%, (28.3±3.3)% and (2.0±2.7)%, respectively, while the NDI of the PSR group was (57.6±3.2)%, (28.0±3.0)% and (2.2±2.1)%, respectively. The NDI of the two groups after operation and at final follow-up were significantly lower than that before operation(P<0.05), and there was no difference between groups(P>0.05). The preoperative and postoperative DAAF of the JeRP group was 6.8±3.4mm and 1.3±1.7mm, respectively, while in PSR group, the values were 7.1±2.2mm and 4.4±5.3mm, respectively. Postoperative DAAF in both groups was significantly lower than that before operation(P<0.05), and postoperative DAAF in JeRP group was significantly lower than that in PSR group(P<0.05). The DPAF was 1.9±1.4mm and 1.8±1.3mm in the JeRP group before and after operation, and 2.2±2.0mm and 0.8±1.3mm in the PSR group. Postoperative DPAF in both groups was significantly lower than that before operation(P<0.05), and postoperative DPAF in JeRP group was higher than that in PSR group(P<0.05). The preoperative, postoperative and final follow-up LMD of the JERP group was 5.8±2.9mm, 0.9±1.5mm and 0.7±1.3mm, respectively, while the LMD of the PSR group was 5.6±3.7mm, 3.0±3.3mm and 2.7±3.6mm, respectively. The LMD of the two groups after operation and at final follow-up was significantly lower than that before operation(P<0.05), and the postoperative and final follow-up LMD of JeRP group was significantly lower than the PSR group(P<0.05). The R-J distance of the JeRP group before and after operation, and at final follow-up was 38.2±5.3mm, 41.1±4.8mm, 40.9±4.7mm, respectively, while that of the PSR group was 37.3±3.0mm, 38.6±2.3mm and 38.4±2.2mm, respectively. The postoperative and final follow-up R-J distance of the two groups was significantly higher than that before operation(P<0.05), the R-J distance after operation and at final follow-up in JeRP group was greater than that in PSR group(P<0.05). There was no difference in the incidence of postoperative complications between the two groups(P>0.05). The fracture fusion rate of the JeRP group was higher than that of the PSR group at 3 months after surgery(59.1% vs 18.2%, P<0.05), but there was no difference between the two groups at 6 months after surgery(86.4% vs 63.6%, P>0.05). Conclusions: The above mentioned two single-segment fixation techniques can both achieve satisfactory clinical effects in treating unstable atlas fractures. Transoral anterior JeRP fixation is better than posterior horizontal screw-rod fixation in fracture reduction and short-term fracture fusion, but the length of hospital stay is longer.