| Objective:To explore the choice of surgical treatment for senile type II odontoid fracture by comparing the curative effect of anteroposterior approach in 20 cases of senile type II odontoid fracture in our hospital.Method:Retrospective analysis was performed on 20 elderly patients over 60 years old with odontoid fracture in our hospital from 2011 to 2020.Surgical treatment was performed and follow-up was obtained.The follow-up time was 6-24 months,with an average of 13 months.According to the surgical methods,they were divided into two groups: anterior odontoid screw fixation(10 cases)and posterior atlantoaxial fusion fixation(10 cases).The operative time,intraoperative blood loss,surgical cost,intraoperative and postoperative complications,VAS score for neck pain,JOA score for neurological function,postoperative NDI score for cervical function,postoperative improvement of cervical range of motion,fracture healing or fusion rate,and ASIA spinal cord injury grade were analyzed in the two groups.Results:1.Perioperative conditions: 117.5±34.00 minutes in the anterior approach group and 166.00±56.11 minutes in the posterior approach group,the time spent in the anterior approach was significantly shorter than that in the posterior approach group,and the difference was statistically significant(P<0.05);Comparison of intraoperative blood loss: anterior group 28.00±7.15 ml,posterior group 161.00±59.90 ml,anterior group was less than the posterior group,the difference was statistically significant(P<0.05);Operation cost comparison: anterior approach group 28338.60±9583.83 yuan,posterior approach group 59602.80±14496.26 yuan,the difference was statistically significant(P<0.05).2.VAS score for neck pain: 7.00±0.82 preoperatively and 0.80±0.63 postoperatively in the anterior approach group,7.20±0.79 preoperatively and1.50±0.71 postoperatively in the posterior approach group.There was statistical difference in the improvement of postoperative anterior and posterior approach scores(P<0.05).3.Joa score of cervical nerve function: 16.10±0.86 preoperatively and17.00±0.00 postoperatively;7.20±0.79 preoperatively and 16.60±0.52 postoperatively in the posterior approach group;the improvement of anterior and posterior approach scores was statistically significant(P<0.05).4.Postoperative NDI score of cervical spine function: preoperative 41.80±1.87 and postoperative 6.10±0.57 in the anterior approach group;preoperative 42.00±1.83 and postoperative 6.30±0.95 in the posterior approach group;postoperative improvement of anterior and posterior approach scores was not statistically significant(P>0.05).5.Postoperative improvement of cervical motion: flexion and extension function(94.00±9.94° in the anterior group and 83.50±11.07° in the posterior group),rotation function(103.5±11.32° in the anterior group and 66.50±13.13° in the posterior group).The degree of cervical motion loss in the anterior approach was significantly lower than that in the posterior approach,with a statistically significant difference(P<0.05).6.Comparison of intraoperative and postoperative complications: 5 cases of postoperative pharyngeal discomfort and pharynx pain occurred in the anterior approach group,and 4 cases of postoperative pharynx discomfort and pharynx pain occurred in the posterior approach group.The anterior approach group was slightly higher than the posterior approach group,but there was no statistically significant difference between the two groups,and no serious complications occurred in either group.7.Fracture healing rate and fusion rate: Bone healing was achieved in both groups within 3-4 months after surgery,and the healing(fusion)rate was 100%.No screw loosening,peeling or screw breaking occurred in 20 patients.Conclusion:Both anterior odontoid cannulated screw fixation and posterior atlantoaxial fusion internal fixation can effectively treat Ⅱ type odontoid fracture in the elderly,and the clinical effect is satisfactory.In the absence of contraindications,anterior odontoid cannulated screw internal fixation is more effective in the treatment of Ⅱtype odontoid fractures in the elderly.Posterior surgery is recommended for odontoid fractures with contraindications to anterior surgery.Poerior atlantoaxial fusion and internal fixation for the treatment of Ⅱ type odontoid fracture in the elderly has fewer complications,wide indications and high fracture healing rate... |
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