Objective:To evaluate the axial instrument strategy for atlantoaxial dislocation with complex vertebral artery variation.Methods:A total of 55 patients with atlantoaxial dislocation who underwent surgical treatment from January 2019 to December 2021 were retrospectively analyzed, including 14 males and 41 females, aged 54.0±12.8 years (range, 22-78 years). Among these patients, 10 patients with unilateral vertebral artery high ride with contralateral vertebral artery occlusion, 30 patients with bilateral vertebral artery high ride with single dominant vertebral artery, 15 patients with bilateral vertebral artery high ride. All patients underwent posterior reduction and internal fixation. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were used to evaluate the postoperative efficacy.Results:All patients completed the surgery successfully with a follow-up time of 14.6±5.5 months (range, 6-24 months). C 2 pedicle screw fixation was performed on the non-dominant side of unilateral vertebral artery high ride and the non-dominant side of bilateral vertebral artery high ride with one dominant vertebral artery (40 vertebraes). The dominant side of unilateral high vertebral artery and bilateral high vertebral artery with one dominant vertebral artery was fixed with C 2 medial "in-out-in" screw (10 vertebraes), C 2 isthmus screw (21 vertebraes), C 2 without screw (9 vertebraes) only extended the fixed segment. For bilateral vertebral artery high ride patients, one side was used C 2 "in-out-in" pedicle screws (right 10 vertebraes, left 5 vertebraes), and the other side was fixed with C 2 medial "in-out-in" screw (8 vertebraes), C 2 isthmus screw (5 vertebraes), C 2 without screw only extended the fixed segment (2 vertebraes). The JOA scores were 8.5±1.8, 13.9±1.3, and 14.4±1.1 preoperatively, 6 months postoperatively, and at the final follow-up, respectively, with statistically significant differences ( F=279.40, P<0.001). JOA at 6 months postoperatively and at the final follow-up was greater than preoperatively, and the differences were statistically significant ( P<0.05), whereas the differences in JOA scores at 6 months postoperatively and at the final follow-up was not statistically significant ( P>0.05). Preoperative, 6 months postoperatively and final follow-up cervical VAS scores were 3.7±1.9, 2.1±0.9 and 1.6±1.0, respectively, with statistically significant differences ( F=39.53, P<0.001). The cervical VAS at 6 months postoperatively and at the last follow-up was less than that before surgery, and the differences were statistically significant ( P<0.05). Cervical VAS scores at 6 months postoperatively were greater than at the last follow-up, with a statistically significant difference ( P<0.05). Conclusion:For patients with atlantoaxial dislocation with complex vertebral artery variation, C 2 lateral "in-out-in" screw, C 2 medial "in-out-in" screw, isthmus screw fixation or C 2 without screw only extended the fixed segment can obtain good clinical efficacy.

Objectives:To explore the operative strategies of revision surgery after atlanto-axial dislocation(AAD)surgery.Methods:12 patients undergone AAD revision surgery in our hospital between January 2016 and August 2019 were analyzed in this retrospective study,including 3 males and 9 females,aged 7-62 years[45.5(34.25,52.50)years].The interval of initial operation and revision operation was 3-360 months[30(5,93)months].Internal fixation and bone graft were removed before revision surgery.The patients were assessed to receive anterior release according to the conditions of 1/6 body weight dose skull traction.According to preoperative imaging and intraoperative exploration,larger diameter and longer screws,new screw track,and extended fixed segments were performed optionally to increase the overall internal fixation strength,and the lateral atlantoaxial joint release and grafting were performed to increase bone graft fusion.The follow-up peri-od ranged 12-50 months[24.0(17.25,34.00)months].The atlanto-dental interval(ADI),clivus-axial angle(CAA),cervico-medullary angle(CMA)and Japanese Orthopaedic Association(JOA)score were assessed at 3 days after surgery and final follow-up,the CT examination was performed at 3 days,3 months,6 months,12months and final follow-up after surgery to evaluate the bone graft fusion.Results:There were 8 patients receiving inter-nal fixation and bone graft removing before revision surgery.Among the patients,4 received anterior releasing combined with posterior reduction and internal fixation and fusion,the other 8 patients underwent posterior reduction and internal fixation and fusion.Of all the patients,occipital screw revision was performed in 4 with new screw track;C1 screw revision was performed in 4,of which 2 patients were fixed with larger di-ameter and longer screws,and 2 patients were fixed with new screw track;C2 screw revision was performed in 8,of which 5 patients were fixed with larger diameter and longer screws,and 3 patients were fixed with new screw track;extended fixed segments were preformed in 3 patients;the lateral atlantoaxial bone grafting was performed in all 12 patients.Anatomical reduction was obtained in all the patients.The postoperative 3d and final follow-up ADI were significantly reduced compared with pre-operative ADI,and the CCA and CMA were significantly increased than those at pre-operation(P＜0.05).The JOA at 3 days after surgery and final follow-up were significantly improved than that at pre-operation.Bony fusion was achieved in all the patients,with a bone fusion rate of 100％,and the bone fusion time ranged 3-7 months[3.5(3.0,6.0)months].Con-clusions:Anterior release is suitable for the patients with un-reduced atlantoaxial dislocation after removal of primary internal fixation under heavy traction.During posterior revision surgery,occipital screws need to change trajectory to maintain firm internal fixation,and larger diameter and longer screw is suitable for C1,and C2 screws,while extended fixed segments are suitable for patients whose C1 or C2 screws cannot be in-serted.The lateral atlantoaxial joint bone grafting is suitable for all AAD revision.

Objective:To investigate the clinical efficacy of medial "in-out-in" axial pedicle screw in the treatment of atlantoaxial dislocation or instability during upper cervical spine surgery.Methods:Thirty-one patients with atlantoaxial dislocation or instability, admitted to our hospital from January 2017 to January 2020, were chosen in our study; 17 patients were with unilateral stenosis at the pedicle of vertebral arch, including 15 with dominant vertebral artery and 2 with unilateral vertebral artery, and medial "in-out-in" axis pedicle screw was placed on this side and conventionally axis pedicle screw was implanted on the other side; 14 patients were with bilateral stenosis at the pedicle of vertebral arch, including 13 with dominant vertebral artery and one with unilateral vertebral artery, and the medial "in-out-in" axial pedicle screw weas placed on the side of the dominant or unilateral vertebral artery and the medial or lateral "in-out-in" axial pedicle screw was inserted on the other side. X-ray, CT, and MRI were performed before, and 5 d and 3, 6, and 12 months after surgery to observe the fusion of bone grafts. Scores of visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) were compared before surgery, and 7 d, and 3 and 6 months after surgery, and during the last follow-up to evaluate the clinical efficacy of these patients.Results:The surgical time was (164.2±28.3) min (136-224 min); the intraoperative blood loss was (283.6±74.5) mL (180-560 mL), and there was no spinal cord vascular injury or other serious complications. Two patients had cerebrospinal fluid leakage after surgery, the drainage tube was pulled out after a delay of 8 d, and the wounds healed at one stage. The distal end of the screw did not enter the vertebral body of one patient during the surgery, and the screw was inserted again after the distal end was tapped to enter the vertebral body. Follow up for 9-25 months was performed in all patients, with an average of 13 months. The imaging examination showed no loosening of internal fixation, fracture, or fusion of bone grafts at 6 months after surgery. Seven d, and 3 and 6 months after surgery and during the last follow-up, the VAS scores were 1.56±0.98, 1.13±1.01, 1.11±0.86 and 1.09±0.91, respectively, which were significantly lower than those before surgery (3.52±1.97, P<0.05); the JOA scores were 11.8±2.1, 12.3±1.9, 12.5±2.2, and 12.6±1.8, respectively, which were significantly improved as compared with those before surgery (8.2±1.7, P<0.05). Conclusion:The use of medial "in-out-in" axial pedicle screw posterior fusion and internal fixation has a positive clinical effect in treatment of atlantoaxial dislocation or instability during upper cervical spine surgery.

Objective:To compare the efficacy of posterior atlas uniaxial and polyaxial screw instrumentation and fusion with bone graft for Gehweiler type IIIb atlas fracture.Methods:A retrospective cohort study was performed to analyze the clinical data of 36 patients with Gehweiler type IIIb atlas fracture admitted to Henan Provincial People′s Hospital from January 2015 to October 2020. There were 29 males and 7 females, with age range of 23-82 years [(48.8±15.5)years]. All patients were treated with posterior atlas screw-rod internal fixation and fusion with bone graft, of which 14 received atlas uniaxial screw internal fixation (uniaxial screw group) and 22 received atlas polyaxial screw internal fixation (polyaxial screw group). The operation time and intraoperative blood loss were compared between the two groups. The atlas fracture union rate and atlantoaxial posterior arch bone fusion rate were compared between the two groups at 3 months and 6 months after operation. The anterior atlantodental interval (ADI), basion-dens interval (BDI) and lateral mass displacement (LMD) were compared between the two groups to evaluate the reduction of fracture fragments before operation, at 1, 3, 6 months after operation and at the last follow-up. At the same time, the visual analogue scale (VAS) and neck dysfunction index (NDI) were compared between the two groups to evaluate neck pain and functional recovery. The postoperative complications were observed.Results:All patients were followed up for 12-44 months [(27.2±9.9)months]. There was no significant difference in operation time or intraoperative blood loss between the two groups (all P>0.05). The atlas fracture union rate and atlantoaxial posterior arch bone fusion rate were 85.7% (12/14) and 78.6% (11/14) in uniaxial screw group at 3 months after operation, insignificantly different from those in polyaxial screw group [72.7% (16/22) and 77.3% (17/22)] (all P>0.05). All patients in the two groups achieved bone union and fusion at 6 months after operation. There was no significant difference in ADI between the two groups before and after operation (all P>0.05). The BDI in the two groups did not differ significantly before operation ( P>0.05), but a significantly higher value was found in uniaxial screw group at 1, 3, and 6 months after operation and at the last follow-up [(5.9±1.3)mm, (5.8±1.3)mm, (5.9±1.2)mm and (5.8±1.2)mm] than in polyaxial screw group [(3.1±0.6)mm, (3.1±0.6)mm, (3.1±0.6)mm and (3.1±0.6)mm] (all P<0.01). The two groups did not differ significantly before operation ( P>0.05), but LMD at 1, 3, and 6 months after operation and at the last follow-up was (1.6±0.8)mm, (1.5±0.8)mm, (1.5±0.7)mm and (1.5±0.9)mm in uniaxial screw group, significantly lower than that in polyaxial screw group [(4.8±1.6)mm, (4.6±1.6)mm, (4.9±1.6)mm and (4.9±1.6)mm] (all P<0.01). There was no significant difference in VAS between the two groups before operation ( P>0.05). The VAS at 1, 3, and 6 months after operation and at the last follow-up was 3.0(3.0, 4.0)points, 2.0(1.0, 2.0)points, 1.0(0.8, 2.0)points and 1.0(0.0, 1.3)points in uniaxial screw group and was 3.5(3.0, 4.0)points, 2.0(2.0, 3.0)points, 2.0(1.0, 2.0)points and 2.0(1.0, 3.0)points in polyaxial screw group. In comparison, the VAS scored much lower in uniaxial screw group than in polyaxial screw group at 6 months after operation and at the last follow-up (all P<0.01). There was no significant difference in NDI between the two groups before operation ( P>0.05). The NDI at 1, 3, and 6 months after operation and at the last follow-up was 34.9±6.3, 23.4±6.2, 13.9±2.7 and 9.4±2.8 in uniaxial screw group and was 33.2±6.1, 24.4±6.3, 18.1±4.1 and 12.7±3.2 in polyaxial screw group, showing a significantly lower NDI in uniaxial screw group than in polyaxial screw group at 6 months after operation and at the last follow-up (all P<0.01). The complication rate was 21.4% (3/14) in uniaxial screw group when compared to 22.7% (5/22) in polyaxial screw group ( P>0.05). Conclusion:For Gehweiler type IIIb atlas fracture, both techniques can attain atlas fracture union and atlantoaxial posterior arch bone fusion, but the posterior atlas uniaxial screw instrumentation and fusion is superior in reduction of atlas fracture displacement and lateral mass separation, neck pain relief and functional improvement.

Objective:To investigate the effects of different surgical time points on the treatment efficacy of acute traumatic central cord syndrome (ATCCS).Methods:Retrospectively analyzed were the 84 ATCCS patients who had been treated at Department of Spinal Surgery, Henan Provincial People's Hospital from January 2013 to February 2021. According to the surgical timing, the patients were divided into 3 groups. In group A (surgery < 48 hours) of 16 cases, there were 11 males and 5 females, aged from 43 to 76 years; in group B (surgery within 3 to 7 days) of 41 cases, there were 31 males and 10 females, aged from 41 to 78 years; in group C (surgery within 8 to 14 days) of 27 cases, there were 15 males and 12 females, aged from 46 to 83 years. Anterior, posterior or combined anterior and posterior approaches were used according to their specific condition. The American Spinal Injury Association (ASIA) motor scores and Japanese Orthopaedic Association (JOA) scores at admission, 7 days and 12 months after operation, postoperative ICU duration, and complications were compared among the 3 groups.Results:There were no significant differences in the preoperative general information or surgical approaches among the 3 groups, showing they were comparable ( P> 0.05). In all patients, the ASIA motor scores and JOA scores at 7 days and 12 months after operation were significantly better than those at admission, and the ASIA motor scores and JOA scores at 12 months after operation were significantly better than those at 7 days after operation ( P<0.01). There was no significant difference in the ASIA motor score or JOA score between the 3 groups at 7 days or 12 months after operation ( P>0.05). The postoperative ICU duration in group A was 42 (26, 61) h, significantly longer than 23 (16, 35) h in group B and 24 (14, 38) h in group C ( P<0.05). There were no deaths in the 84 patients; there was no significant difference in the overall incidence of serious complications or in that of general complications among the 3 groups ( P>0.05). Conclusions:Surgery is safe and effective for ATCCS. However, decompression surgery within 2 weeks may achieve better outcomes.

Objective:By observing rapid postural reduction combined with internal fixation in the treatment of thoracolumbar compression fracture,to provide new ideas for the treatment of the patients with thoracolumbar compression fracture.Methods:The patients with thoracolumbar compression fracture in accordance with the inclusion criteria were selected.Before operation,the patients were given rapid postural reduction,and combined with internal fixation during operation in the treatment of thoracolumbar compression fracture.The fanterior edge compression rates, pain scores(VAS score),JOA scores,symptoms,signs scores and postoperative complications,intraoperative bleeding,operation time and other clinical indicators of patients were observed before and after the operation.Results:The operation time was 47~102 minutes,the average was 56 minutes,the intranperative bleeding was 153~390 mL,the average was 187 mL.Patients were followed up for 12~22 months after operation, the average was 16 months.In the last follow-up,the fanterior edge compression rate by preoperative (0.423±0.145) reduced to (0.104±0.031),preoperative VAS score (6.32±1.47) reduced to (0.23±0.11),preoperative JOA score (14.21±1.82) increased to (27.93±0.96),preoperative symptoms,signs scores (16.73±1.31) reduced to (2.13±0.29).Conclusion:Rapid postural reduction combined with internal fixation in the treatment of thoracolumbar compression fracture can ideal restore and maintain vertebral height,its clinical complications are less,the pain of patients is significantly reduced.It is a new way to treat thoracolumbar compression fracture.

Objective To investigate the AO compression screw hollow the treatment of senile femoral neck fractures. Methods Ways in the C-arm X-ray machine to monitor the use of AO hollow compression screw for the treatment of age-47 cases of femoral neck bone. Results The results after 2.5~4 years of follow-up, functional assessment of Harris score criteria, 35 cases of excellent, good in 8 cases, good rate of 91.5%, 44 cases of fracture healing, the healing rate of 93.6%, healing time was 4~12 months with an average of six months, 3 example happen avascular necrosis of femoral head, femoral head necrosis rate of 6.4%. Conclusion Hollow compression screw for the treatment of senile femoral neck fracture, surgical trauma with a small, simple operation, fi xation, less complications, etc., are the treatment of senile femoral neck fracture in a satisfactory method.

目的:总结手法复位夹板固定治疗小儿肱骨髁上骨折的经验.方法:选取2006年3月至2009年1月新鲜闭合性小儿肱骨髁上骨折70例,治疗组37例,进行手法复位夹板固定治疗,对照组33例采取肘部内外侧联合切口切开复位内固定治疗,两组均随访6个月～1年.结果:治疗组总优良率为91.89%,对照组优良率87.88%.经卡方检验,χ2=0.3121,P=0.5764＞0.05,两组疗效无明显差异.结论:两组疗效无明显差异,均较满意.但是手法复位夹板固定治疗小儿肱骨髁上骨折,患者痛苦小、恢复快、效果好、后遗症少,方法简单,安全可靠,还避免了手术感染及二次手术取内固定之弊,为治疗该种骨折的首选方法.