Comparison of prefabricated path with an awl for guiding pin and traditional screw placement in anterior odontoid screw fixation / 中华创伤杂志

ABSTRACT

Objective:To compare the application value of prefabricated path with an awl for guiding pin and traditional screw placement during anterior odontoid screw fixation.Methods:A retrospective case-control study was conducted to analyze 35 patients with fresh odontoid fractures treated from January 2010 to August 2017 in Henan Provincial People's Hospital, including 25 males and 10 females with age range of 19-55 years (mean, 36.9 years). The preoperative odontoid fractures were classified into type IIA in 15 patients, type IIB in 20 patients according to Anderson and D'Alonzo classification. Among them, 16 patients in Group A were treated with prefabricated path by an awl for guiding pin during anterior odontoid screw fixation, and 19 patients in Group B were implanted screws according to traditional experience in anterior odontoid screw fixation. Operation time, intraoperative fluoroscopy time, success rate of first-time guiding pin implantation, intraoperative blood loss, fracture healing outcomes and American Spinal Injury Association (ASIA) grade at the latest follow-up were collected and compared between the two groups.Results:All patients were followed up for 13-20 months [(16.8±1.5)months]. Two groups had significant differences in operation time [Group A (73.5±12.9)minutes; Group B (82.6±13.6)minutes], intraoperative fluoroscopy time [Group A (3.1±0.6)minutes, Group B (7.0±0.9)minutes], and success rate of first-time guiding pin implantation (Group A 94%, Group B 58%) ( P<0.05), but not in intraoperative blood loss [Group A (129.4±40.6)ml; Group B (135.8±38.4)ml] and fracture healing rate (Group A 94%, Group B 95%) and ASIA grade at the latest follow-up (Group A grade C in 1 patient, grade D in 3, grade E in 12; Group B grade C in 2 patients, grade D in 2, grade E in 15) ( P>0.05). All patients were successfully operated without occurrence of cerebrospinal fluid leakage, neurovascular injury or incision infection. Conclusions:Prefabricated path with an awl for guiding pin during anterior odontoid screw fixation is superior to traditional experience, which can reduce operation time, intraoperative fluoroscopy time and improve the success rate of first-time guiding pin implantation. Meanwhile, there is no effect on intraoperative blood loss or fracture healing outcomes.