Diagnosis and treatment for complicated atlantoaxial dislocation / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinical characteristics and treatment methods for complicated atlantoaxial dislocation.</p><p><b>METHODS</b>A retrospective evaluation was done to summarize and analyze the clinical characteristics and complicated factors of 54 patients with complicated atlantoaxial dislocation who could not to be treated effectively by using conventional therapy in our hospital from February 2005 to October 2008. According to different complicated factors, different treatment methods mainly including transoral atlantoaxial reduction plate-III (TARP-III) operation, decompression procedure with deep grinding guided by computer aided design-rapid prototyping (CAD-RP), screw placement technique with CAD-RP guide plate and extensile approach surgery were performed.</p><p><b>RESULTS</b>The average follow-up period was 24 months. Among 54 cases, 48 cases achieved immediate anatomic reduction completely and 6 cases almost achieved anatomical reduction. All the compressed spinal cords were decompressed sufficiently. The decompression rate was 86.0% and the improvement rate of nerve function was 77.8%. Two cases suffered postoperative intracranial infection.</p><p><b>CONCLUSION</b>Some cases of complicated atlantoaxial dislocation can be effectively treated by using TARP-III operation, decompression procedure with deep grinding guided by CAD-RP, individualized screw placement technique with CAD-RP guide plate and extensile approach surgery.</p>

Transoral atlantoaxial reduction plate fixation for irreducible atlantoaxial dislocation / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To design a clinically applicable transoralpharyngeal atlantoaxial reduction plate (TARP), introduce the operation procedure, and evaluate its preliminary clinical effects.</p><p><b>METHODS</b>A novel TARP system, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operational instruments was developed. This system was applied clinically on five patients with irreducible atlantoaxial dislocation of congenital or traumatic origin. During operation, the reduction was completed by the combined action of the plate and the atlantoaxial reductor after transoral joint release and cord decompression. Bone graft granules were implanted between the bilateral atlantoaxial joints and TARP was used to immobilize subsequently the atlas and axis.</p><p><b>RESULTS</b>Clinical application demonstrated that TARP could induce instant reduction and that the method was operationally feasible and its postoperational effect was satisfactory.</p><p><b>CONCLUSIONS</b>The design of TARP is novel. The operational procedure is simple and easy to use. Furthermore, instant reduction can be completed during the operation and the fixation is relatively stable. TARP is an ideal alternative for irreducible atlantoaxial dislocation and may have excellent prospects for further clinical applications.</p>

Design and preliminary clinical application of transoralpharyngeal atlantoaxial reduction plate / 中华外科杂志

<p><b>OBJECTIVE</b>To design transoralpharyngeal atlantoaxial reduction plate (TARP), evaluate its biomechanical performance and observe its preliminary clinical effect.</p><p><b>METHODS</b>A brand-new TARP system was designed, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operation instruments. Twelve fresh occipital bone-C(3) specimen were designed for biomechanical test including range of motion (ROM) (n = 6) and screw pull-out strength (n = 12). Preliminary clinical application of TARP was reported.</p><p><b>RESULTS</b>The reduction mechanism of the TARP system was designed cleverly. TARP had equal effect with Magerl + Brooks and it was more stable than the other three clinically widely used atlantoaxial fixators: Magerl, Brooks and anterior transarticular screw fixation through C(2) vertebral body. TARP's C(1) and C(2) screws were strong enough for atlantoaxial arthrodesis and their antipull-out performance was excellent. Clinical application on irreducible atlantoaxial dislocation proved that TARP had the function of instant reduction, the operation was feasible and the operation effect was significant.</p><p><b>CONCLUSION</b>TARP's design is novel and it has excellent biomechanical performance. The operation procedure is simple and reasonable. Furthermore, instant reduction could be completed during the operation and the fixation is strong. Above all, TARP is creative and will have excellent prospect.</p>