Clinical Application And Research Of Atlantoaxial Pedicle Screw Fixation Assisted By Navigation Template

ObjectiveTo explore the accuracy and clinical feasibility of atlantoaxial pedicle screw fixation assisted by navigation template and provide reference for the clinical application of pedicle screw fixation.MethodThe clinical data of patients with atlantoaxial fractures and dislocations treated by posterior pedicle screw fixation in our hospital from December 2014 to December 2016 was collected.According to the inclusive and exclusive criterion for this study a total of 24 cases of patients were included and divided into experimental group and control group by the principles of randomization.12 cases in the experimental group was nailed via navigation template assisted while 12 cases in control group was nailed by hand.1.The patients in the two groups were given routinal CT scan and the accuracy of the screw fixation in the two groups was evaluated by criterion of S.Kaneyama and statistically analysized.2.The operation time,intraoperative blood loss and fluoroscopy times of the two groups were recorded and statistically analysized.3.The JOA and VAS scores of patients in the two groups were recorded at scores were statistically analysized.Result1.All the 12 patients in experimental group were placed with 48 atlantoaxial pedicle screws,including 48 in grade 0,0 in grade I、II and III,with the accuracy of 100%(grade 0 and grade I were seemed as satisfactory)while all the 12 patients in control group were placement of 48 atlantoaxial pedicle screws,including 34 in grade 0,11 in grade I,3 in grade II and 0 in grade III,with the accuracy of 93.75%.There was significant difference between the two groups(P < 0.01).2.The average operation time of the experimental group and control group were 147.35±32.90 min and 171.40±34.12 min respectively which were significant difference(P <0.01).The mean intraoperative fluoroscopy times were 2.05±0.81 times and 5.45±1.39 times respectively which were statistically significant difference(P < 0.01).The average intraoperative blood loss was 331.10±83.71 ml and 372.15±75.46 ml respectively which were statistical difference(P < 0.01).3.The JOA scores of patients at preoperation and six months of postoperation in experimental group were 11.91±3.12 and 15.31±1.12 respectively which were statistically significant difference(P < 0.01)while those in control group were 12.13 ±2.32 and 15.45±0.98 respectively which were statistical difference(P < 0.01).The JOA scores of patients at preoperation and six months of postoperation in both group was no significant difference(P > 0.05).4.The VAS scores of patients at preoperation and six months of postoperation in experimental group were 5.76±1.42 and 1.91±0.72 respectively which were statistically significant difference(P < 0.01)while those in control group were 5.61 ±1.57 and 2.05±0.68 respectively which were statistical difference(P < 0.01).The VAS scores of patients at preoperation and at six months of postoperation in both group was no significant difference(P > 0.05).ConclusionCompared with the traditional pedicle screw fixation:1.navigation template could significantly improve the accuracy of screw placement;2.navigation template could significantly reduce the operation time,intraoperative fluoroscopy times and intraoperative blood loss;3.navigation template in the preoperative and postoperative JOA and VAS scores had the same function on improving the situation with the unarmed nail.Navigation template assisted atlantoaxial pedicle screw fixation was more valuable than the manual nail and had high clinical feasibility.