Clinical Efficacy Analysis Of Pedicle Screw Fixation In The Treatment Of Odontoid Fracture With Atlantoaxial Instability

Objective: The aim of this study was to analyze the technique of pedicle screw fracture clinical curative effect and safety of patients with atlantoaxial instability in the treatment of odontoid process,in order to provide the basis with atlantoaxial instability patients for the clinical treatment of odontoid fracture.Methods: By analyzing retrospective cases,23 patients(5 cases accompanied by cervical spinal cord injury)with atlantoaxial instability(Upper cervical instability)caused by odontoid fractures in our hospital were selected from May 2007 to June 2016,including 16 males and 7 females,with a mean age of years(range,28-52)of about 41.2year.All cases underwent posterior atlantoaxial pedicle screw fixation and iliac bone graft fusion.Scored by cervical function rating scale(the lower the score is,the more significant of the postoperative effect is)and VAS visual analogue pain score(the higher the score is,the more severe of the pain is),the postoperative symptoms and neurological function improvement were evaluated.At the same time,the time of operation,the amount of bleeding and the incidence of postoperative complications were recorded.The internal fixation,fracture healing and bone graft fusion were evaluated by imaging data.Results: The operation was completed successfully in this group.The operation time ranged from 105 to 165 min,with an average of 127 min.The intraoperative blood loss was 150~550 ml,with an average of 245 ml.No vertebral artery and spinal cord injuries occurred during the operation.All the patients were followed up for 6~48 months,with an average of 16 months.During the follow-up period,no loosening,displacement,screw breakage,atlantoaxial transposition and instability were found in the imaging.The follow-up time of fracture healing and fusion was 5.2 to 10.2 months,with an average of 6.8 months.All the odontoid fractures healed and atlantoaxial fusion was achieved.At the end of the follow-up,cervical pain disappeared,neurological symptoms(numbness,hyperalgesia,decreased muscle strength,defecation difficulties)were significant recovery;cervical flexion,lateral flexion and rotation of normal activities,activities are limited to varying degrees(left-right rotation is about 30 degrees).The scores were significantly improved after operation.The score of cervical spine function was improved from preoperative(13.3±3.1)to postoperative(6.7±3.6)points(P<0.05),the VAS score was improved from preoperative(6.7±3.6)to postoperative(3.5±1.0)points(P<0.05).Conclusion: Atlantoaxial pedicle screw technique in treatment of odontoid process effect with atlantoaxial instability fracture is satisfactory,and it is a reliable and effective operation,has a good reduction,a reconstruction and restoration of spinal cord function for upper cervical stability.However,this clinical study lacks randomized controlled trials,lacks a certain amount of persuasion.Therefore,clinical randomized controlled trials are needed to make the study more convincing in the next study.