Surgical Strategy And Clinical Results Of Reserving Atlantoaxial Joint Function In Complex Axis Fractures

Objectives:To investigate the clinical features and diagnosis of complex axis fracture analysis before passing atlantoaxial limited internal fixation(ie fixed or locked by high C2-3 through the hollow interior dens C2 screw fixation combined with internal titanium or high C2- 3 locking titanium plate fixation) and apply a C1-3 posterior pedicle + C2-3 interbody fusion surgery, two-line atlas of surgical screw removal surgery, discuss maximize the retention of the atlas feasibility atlantoaxial rotation function, for surgical treatment of complex fractures of atlantoaxial provide better choice and new ideas.Methods: Wuhan General Hospital of Guangzhou Command by case retrieval systems and PACS imaging systems orthopedic hospital since February 2005 to January 2013 atlantoaxial fracture patients treated complex cases, imaging data and follow-up data, and to organize, analysis. From the patients meet the complex atlantoaxial fracture diagnosed patient selection criteria and determine exclusion criteria for patients included in the study were followed up regularly on the basis of a particular method, including follow-up of patients with symptoms, signs and imagingdata, remove the case off, identify research The final object. All patients in this study were fresh fractures. Mainly depends on the type of fracture diagnostic imaging data, including the cervical spine, shoulder and mouth bit X-ray, CT scan + three-dimensional reconstruction and MRI, fracture type involved in this study include: vertebral axis sagittal fracture consolidation Ⅱ odontoid fracture with C1-2 instability one case, atlantoaxial vertebral fracture associated with coronal type Ⅱ odontoid fracture with C1-3 instability in four cases, type Ⅱ odontoid fracture combined with C1 fractures HangmanⅡ-3 instability in two cases, type Ⅱ odontoid fracture combined with C1-3 Hangman Ⅲ fracture instability one case, HangmanⅡ atlantoaxial vertebral fractures merge the lower levels of comminuted fracture of two cases with C1-3 instability, HangmanⅡ type merger vertebral axis sagittal fracture with C2-3 instability two cases, HangmanⅡ type merger vertebral axis coronal plane fracture associated with C2-3 instability five cases, vertebral axis coronal plane fracture slip forward merger HangmanⅠ type C1-3 unstable fractures with one case. According atlantoaxial fracture cases, C1-3 spinal cord compression degree of stability and direction were to be anterior odontoid screw within the C2 + anterior plate fixation(one case), anterior odontoid screw + C2-3 anterior discectomy fusion with plate fixation(9 cases), C2-3 anterior discectomy and fusion with plate fixation(7 cases), C1-3 posterior pedicle + C2-3 interbody fusion surgery, two-line atlas screw removal surgery(1 case). Postoperative quality combined with the patient’s own circumstances, be wearing a cervical collar chest or head and neck brace or cast immobilization protectionthree months. And regular X-ray(or CT scan, if necessary) examination, patient symptoms at different times, objective signs and radiographic examination and other follow-up observation of the cervical spine and nerve function improved patient follow-up analysis of the situation.Results: All patients were after 12-72 months(mean 18.44±14.14 months) follow-up, which, after 3 months, 17 patients eligible for bone healing, 1 case of dens fractures in patients with delayed healing, continuing the line also received a cervical collar bone fixation six months after healing. X-ray and CT scans prompted fractures good C1-3 sequence recovery, good stability of the cervical spine, cervical spine function in all patients recovered satisfactorily, with the flexion 33.17°±1.543°, extension 32.89°±2.026°, lateral flexion 53.26°±5.466°, rotation 118.12°±8.772°. Spinal cord injury patients have received varying degrees of improvement: the recovery of spinal nerve according to ASIA classification: 12 cases of spinal cord injury patients improved in 10 cases, including one case of grade B patients improve the D grade, five cases of grade C in two cases of patients improvements to the D grade, 2 cases improved to E grade, 6 cases of grade D 5 cases of patients improve E-Class, E-Class the remaining six cases of patients had no significant change.Conclusions: The key compromise atlantoaxial complex pivot function reserved C2 vertebrae to eliminate the impact of vertebral fractures, reliable before passing vertebral efficacy with limited internal fixation, and "pre-fixed, remove the two fixation" ofcervical posterior nail rod fixation system nicely complements the anterior fixation techniques. This technique for the treatment of complex fractures of axial and retain atlantoaxial joint provides a new way of thinking and method selection, and supplement the fixation of anterior atlantoaxial complex fractures.