Posterior atlantoaxial joint axial release, bone grafting and internal fixation for irreducible atlantoaxial dislocation with partial reduction / 中华创伤杂志

ABSTRACT

Objective@#To investigate the efficacy of posterior atlantoaxial joint axial release, bone grafting and internal fixation for the treatment of irreducible atlantoaxial dislocation (IAAD) with partial reduction.@*Methods@#A retrospective case-control study was conducted to analyze the clinical data of 42 patients with IAAD admitted to Henan Provincial People's Hospital from January 2014 to October 2017. There were 17 males and 25 females, aged from 12 to 72 years [(47.2±11.3) years]. After more than 50% reduction by high weight skull traction, 18 patients underwent posterior atlantoaxial joint axial release, reduction, bone grafting and fusion with internal fixation (Group A), and 24 patients underwent anterior transoral or retropharyngeal release, reduction, posterior bone grafting and fusion with internal fixation (Group B). The operation time, intraoperative blood loss, preoperative and postoperative anterior atlantodental interval (ADI), clivus-canal angle (CCA), cervicomedullary angle (CMA), and Japanese Orthopaedic Association (JOA) scores between the two groups were compared. The improvement rate of JOA scores at the last follow-up of the two groups and the atlantoaxial joint fusion rate at 3 months and 6 months after surgery were calculated and compared. The complications were recorded.@*Results@#All patients were followed up for 12 to 40 months with an average of 24.6 months. Group A had significant decreases in operation time [(138.1±25.6) minutes ∶(242.8±38.1) minutes] and intraoperative blood loss [(179.3±48.7)ml ∶(218.2±42.6)ml] compared with Group B (P<0.05). There were significant differences between the ADI, CCA, CMA and JOA scores before operation and during the last follow-up in both Group A and Group B (P<0.05), but there was no significant difference between the two groups in terms of these scores (P>0.05). The JOA scores in Group A were excellent in eight patients, good in eight patients, and fair in two patients, with the improvement rate of 89%. The JOA scores in Group B were excellent in 13 patients, good in eight patients, and fair in three patients, with the improvement rate of 87% (P>0.05). In Group A, the atlanto-axial joint fusion rate was 83% at 3 months and 100% at 6 months postoperatively; in Group B, the fusion rate was 79% at 3 months and 100% at 6 months postoperatively (P > 0.05). There was no failure of internal fixation or loss of reduction in both groups.@*Conclusion@#Posterior atlantoaxial joint axial release, bone grafting and fusion with internal fixation can be used to treat the partially reducible IAAD through a single approach. The reduction effect was comparable to that of anterior transoral or retropharyngeal release, bone grafting and fusion, with less operation time and intraoperative blood loss.