Observation on the efficacy of posterior atlantoaxial screw rod reduction and internal fixation combined with transplantation of the muscle-vascular complex of the atlantoaxial spinous process in treatment of type ⅡC odontoid fractures
Objective To observe the efficacy of posterior atlantoaxial screw rod reduction and internal fixation combined with transplantation of the muscle-vessel complex of the atlantoaxial spinous process in treatment of type ⅡC odontoid fractures.Methods The clinical data of 95 patients with type ⅡC odontoid fractures who were admitted to the 910th Hospital of Joint Logistic Force of Chinese People's Liberation Army from January 2020 to October 2022 were retrospectively analyzed.The patients were divided into control group(receiving posterior atlantoaxial screw rod reduction and internal fixation combined with iliac bone grafting,47 cases),and observation group(receiving posterior atlantoaxial screw rod reduction and internal fixation combined with transplantation of the muscle-vascular complex of the atlantoaxial spinous process,48 cases) .The operation-related indicators,postoperative fracture healing rate,fracture end and neck stability and atlantoaxial rotation degree were compared between the two groups.Visual Analogue Scale( VAS) scores,American Spinal Injury Association(ASIA) scores,neck disability index(NDI) and Japanese Orthopaedic Association(JOA) scores were compared between the two groups before operation,3 months after operation and 6 months after operation.The complications were compared between the two groups.Results Compared with the control group,the observation group had shorter operation time,less blood loss during operation,and shorter time to fracture healing,and the differences were statistically significant(P＜0.05).The fracture healing rate in the observation group was significantly higher than that in the control group 6 months after operation[93.75％(45/48) vs 78.72％(37/47);x2=4.540,P=0.033].Six months after operation,dynamic X-ray films of cervical flexion and extension showed good stability of the fracture ends and necks in all the patients in the observation group,while four patients in the control group had poor stability of the fracture ends.There was no significant difference in the atlantoaxial rotation degree between the observation group and the control group 3 months after fracture healing[(84.13±6.32)°vs (82.96±7.10)°;t=0.849,P=0.398].The postoperative VAS scores showed a downward trend in both groups(P＜0.05),but there was no significant difference in the magnitude of the change between the groups(P＞0.05).Compared with those before operation,the ASIA scores 3 and 6 months after operation did not change significantly in both groups(P＞0.05),and NDI showed a downward trend in both groups after operation(P＜0.05),and NDI scores in the observation group was significantly lower than that in the control group 3 and 6 months after operation(P＜0.05).The JOA scores showed an upward trend after operation in both groups(P＜0.05),and the JOA scores in the observation group were significantly higher than those in the control group 3 and 6 months after operation(P＜0.05).The incidence of complications in the observation group was lower than that in the control group,but the difference was not statistically significant between the two groups[4.17％(2/48) vs 14.89％(7/47);x2=2.058,P=0.151].Conclusion The posterior atlantoaxial screw rod reduction and internal fixation combined with transplantation of the muscle-vascular complex of the atlantoaxial spinous process can shorten the operation time,reduce intraoperative blood loss,promote fracture healing and facilitate the recovery of physiological function of cervical vertebrae in the treatment of type ⅡC odontoid fractures.
Odontoid fractureInternal fixationFracture healingMuscle-vascular complex of the atlantoaxial spinous process
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