Objective To explore the clinical efficacy of pedicle screw fixation combined with intraoperative CT scanning in the treatment of atlantoaxial instability.Method A retrospective analysis was conducted on 25 patients with atlantoaxial instability treated with posterior transpedicular screw fixation and intraoperative CT scanning from July 2015 to November 2019,22 cases were old insta-bility or dislocation of the atlas axis while 3 cases were fresh fractures or dislocations of the odontoid process.22 cases underwent intra-operative atlantoaxial fixation followed by bone graft fusion,while 3 cases only underwent internal fixation without bone graft fusion.Results All 25 patients successfully completed the surgery,with 50 screws in each atlas and axis.During the surgery,10 positioning pins were corrected after CT scanning,and screws were implanted after adjustment.Both intraoperative CT scanning and postoperative CT reconstruction showed good screw positions;No serious complications such as vertebral artery,spinal cord,or nerve root injuries were found during or after the surgery.A follow-up examination at 6 months after surgery showed satisfactory bone graft fusion.All 3 patients without bone graft fusion were removed with internal fixators after confirming fracture healing at 10 months after surgery.Post-operative CT reconstruction showed that the Gertzbein grading of screw positions was 96 at level 0 and 4 at level 1;After Kappa consis-tency test,the Gertzbein grading results of screw positions displayed on intraoperative CT scans and postoperative CT reconstruction showed very good consistency(Kappa=1).The preoperative JOA score of 16 patients with cervical spinal cord symptoms was(11.3±0.9),the improvement was(14.6±0.8)at 6 months after surgery,and(15.3±0.8)at 1 year after surgery,with a statistically significant difference(P＜0.05).Conclusions Intraoperative CT assisted pedicle fixation can improve the accuracy and surgical safety of screw implantation.The reduction of the atlantoaxial spine can be better judged,achieving good clinical efficacy.
维普
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