| PART 1 Comparison between surgical and conservative treatment of unstable atlas fractureObjective:To compare the clinical efficacy of C1 pedicle screw + "Ω" transverse internal fixation and non-surgical treatment of unstable atlas fractures.Methods: The clinical data of 24 patients with unstable atlas fracture admitted to our hospital from June 2012 to October 2020 were retrospectively analyzed.They were treated with non-surgical methods such as skull traction and Halo frame external fixation support（13 cases,group A）and C1 pedicle screws + "Ω" transverse internal fixation（11 cases,group B）,respectively,and the atlas lateral mass displacement distance（LMD）,vertical distance from the midpoint of the lower edge of the pivot vertebral body to the basal line（R-J distance）,visual analogue scale（VAS）score for cervical pain and cervical dysfunction index（NDI）were recorded and compared between the two groups at 12 months of follow-up,and the length of hospital stay,fracture healing time,time to return to daily life,and complications were also assessed in the two groups.Results: All treatments were successfully completed,followed up for 18 to 26 months,and healed 6 to 9 months after treatment.The clinical symptoms of occipitocervical pain and limited cervical movement were significantly improved during follow-up in both groups.In group A,the hospital stay was（30.00±2.48）d,the recovery time of daily life was（67.31±6.30）d,and the fracture healing time was（8.00±1.29）months;in group B,the hospital stay was（13.36±1.29）d,the recovery time of daily life was（26.45±3.39）d,and the fracture healing time was（6.82±1.33）months.The differences in the length of hospital stay,recovery time to daily life and fracture healing time between the two groups were statistically significant（P < 0.01）.The VAS score and NDI at follow-up were significantly improved in both groups,and the differences were statistically significant（P < 0.01）.The VAS score and NDI of group A were（3.38±1.76）points and 5.46% ± 1.45%,respectively,while those of group B were（1.73±0.79）points and 2.73% ± 1.01%,respectively.There were significant differences between the two groups（P < 0.01）.During follow-up,LMD was（1.93± 0.49）mm and R-J distance was（39.70± 1.03）mm in group A,and（1.36 ± 0.17）mm and R-J distance was（45.65± 1.84）mm in group B.There were significant differences between the two groups（P < 0.05）.Conclusion: C1 pedicle screw + "Ω" transverse internal fixation is effective in the treatment of unstable atlas fracture,with obvious advantages in hospital stay,fracture healing time,recovery of postoperative quality of life and incidence rate of complications,and is more conducive to the preservation of upper cervical spine function.PART 2 Comparison of the efficacy of two non-fused treatments for type II and type IIa Hangman fracturesObjectives:To compare the efficacy of posterior C2 pedicle screw + "Ω" transverse internal fixation and posterior C1-3 non-fusion fixation followed by two-stage internal fixation removal in the treatment of type II and type IIa Hangman fractures.Methods: A total of 37 patients with Hangman fracture who underwent different surgical methods in 904 Hospital of the joint logistics support force of the Chinese people’s Liberation Army from March 2015 to July 2021 were retrospectively analyzed.In Group A,16 patients（male 11,female 5）,aged from 29 to 65（45.6 ± 10.2）,underwent posterior C2 pedicle screw plus "Ω"-shaped transverse fixation.In Group B,21 patients-Malemale 14,female 7)were treated The Age ranged from 30 to 63 years（45.5 ± 9.3 years）.The operation time,intraoperative blood loss,hospital stay,hospitalization costs and fracture healing time,visual analogue scale（VAS）,neck disability index（NDI）and total cervical rotation at follow-up were recorded and compared between the two groups.Results: The clinical symptoms of occipitocervical pain and limited cervical movement were significantly improved during follow-up in both groups.In group A,the operation time was（67.2 ± 11.1）min,intraoperative blood loss was（65.6 ± 18.3）ml,hospital stay was（10.6 ± 1.4）d,and hospitalization cost was（3.5 ± 0.5）000 yuan;in group B,the operation time was（118.6 ± 17.8）min,intraoperative blood loss was（106.7 ± 25.2）ml,hospital stay was（15.1 ± 1.2）d,and hospitalization cost was（7.4 ± 0.5）000 yuan.The differences in the operation time,blood loss,hospital stay and hospitalization costs between the two groups had statistical significance（P < 0.01）.A group of fracture healing time is（9.0 ± 2.3）month,and B group fracture healing time is（9.1.± 2.3）month,and the difference between the two groups had no statistical significance（P > 0.05）.The VAS score and NDI at follow-up were significantly improved in both groups,and the differences were statistically significant（P < 0.01）.The VAS score and NDI of group A were（1.6 ± 0.7）points and 2.3% ± 1.1%,respectively,while those of group B were（2.1 ± 0.7）points and 3.7% ± 1.8%,respectively.There was significant difference between the two groups（P < 0.05）.The total rotation of cervical vertebra was 138.1 ° ± 7.8 ° during follow-up in group A,77.4 ° ± 8.7 ° before internal fixation removal in group B,and 125.9 ° ± 11.9 ° during followup,and the differences had statistical significance（P < 0.05）.Conclusion: Both posterior C2 pedicle screw + "Ω" transverse internal fixation and posterior C1-3 non-fusion fixation are effective in the treatment of type ⅱ and type ⅱ a Hangman fractures,but single-level fixation is more beneficial to the preservation of cervical movement. |
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