Implantation techniques for dislocation of atlas-axis joint: Biocompatibility and biomechanics / 中国组织工程研究

ABSTRACT

BACKGROUND: Gallie, Brooks steel wire, and Halifax vertebral plate clamp are tools for internal fixation of atlas-axis joint. They can keep the flexion-extension stability of atlas-axis joint, but weaken the ability to against lateral bending and rotation. Magerl+Gallie implantation shows good biomechanics stability, but cannot well prevent axial dislocation. OBJECTIVE: To introduce the surgical technique from posterior approach for atlas, and explore the effect on biocompatibility and biomechanics of implants. RETRIEVAL STRATEGY The articles related to atlas-axis joint dated between January 1970 and June 2007 were retrieved through Pubmed, PML, OVID and Wanfang database using of "atlas, axis, dislocation, fixation, posterior" and "atlas, dislocation, internal fixation, implant, posterior approach, biocompatibility, biomechanics" in Chinese. All collected articles were selected firstly and the articles related to implants, surgical skills, and biomechanics were selected. For articles in identical field, only those published in recently or in authoritative journals were selected. Repetitive articles and Meta analysis were excluded. 127 articles met the criteria and 30 of them were involved. LITERATURE EVALUATION The articles involved were related to the surgical treatment of dislocation of atlas-axis joint. Of 30 articles, 3 were review articles, 3 were monographs, and the others were clinical or basic researches. DATA SYNTHESIS: ①Lateral mass and pedicle screw implantation techniques can achieve three-dimensional fixation. ②The screw entrance points of atlantoaxial pedicle screw implantation is higher than lateral mass technique, it is unnecessary to expose C1, posterior arch and other deep parts of anatomic structures. C2 nerve root and venous plexus are not separated completely, which reduce injury rate and blood loss. In addition, screw passage of pedicle screw is longer than Harms technique, so screw can completely contact with skeleton to enhance the fixation. CONCLUSION: Atlantoaxial fixation by posterior pedicle screw implantation shows good biomechanics and biocompatibility. It may become the optimal approach for atlantoaxial short segmental fixation.