Efficacy evaluation of limited internal fixation with posterior titanium plates for unstable atlas fractures / 中华创伤杂志

ABSTRACT

Objective To determine the clinical efficacy of limited internal fixation with posterior titanium plates for unstable atlas fractures.Methods A retrospective case series analysis was performed for 29 patients with unstable atlas fractures immobilized using the posterior titanium plate from January 2011 to November 2014.There were 22 males and seven females,with a mean age of 41.5 years (range,17-68 years).Ten patients were diagnosed with 1/2 ring Jefferson fractures,12 anterior 1/2 Jefferson fractures and seven patients posterior 3/4 Jefferson fractures.Frankel neurological performance scale was grade E in all patients.Operation time,amount of bleeding during operation and postoperative complications were recorded.X-ray and CT were performed to identify the fusion,internal fixation location and atlantoaxial stability.Visual Analogue Scale (VAS) for craniocervical pain and cervical range of motion were evaluated.Results Mean duration of procedure was (86.6 ± 7.8) min (range,68-122 min) and mean blood loss was (120.0 ± 25.3) ml (range,90-400 ml).No vascular and neurologic complications were noted.All patients were followed up for (22.5 ± 18.0)months (range,12-32 months).CT scans confirmed bony union in all patients 6 months after operation.No plate-related complications,implant lessening and implant breakage occurred during the follow-up.Postoperative VAS [(1.9 ± 1.1) points] was significantly lower than that before operation [(7.2 ± 1.4) points] (P ＜ 0.05).At the last follow-up,the ranges of cervical flexion-extension [(81.3 ± 22.2) °] and rotation [(152.4 ±38.7) °] were close to the normal range.Conclusion Limited internal fixation with posterior titanium plates is a safe and effective surgical method that contributes to good reduction and maximal preservation of cervical physiological motion.