|Novel Surgical Classification and Treatment Strategy for Atlantoaxial Dislocations|
|Wang, Shenglin; Wang, Chao; Yan, Ming; Zhou, Haitao; Dang, Gengting|
|关键词||atlantoaxial dislocation classifcation treatment strategy transoral surgery atlantoaxial release|
|WOS标题词||Science & Technology|
|类目[WOS]||Clinical Neurology ; Orthopedics|
|研究领域[WOS]||Neurosciences & Neurology ; Orthopedics|
|关键词[WOS]||OCCIPITOCERVICAL FUSION ; CERVICAL-MYELOPATHY ; INTERNAL-FIXATION ; SCREW FIXATION ; DOWNS-SYNDROME ; PLATE ; DECOMPRESSION ; INSTABILITY ; SUBLUXATION ; MANAGEMENT|
Study Design. Retrospective study of 904 patients with a diagnosis of atlantoaxial dislocation (AAD), using a novel surgical classification and treatment strategy.
Objective. To describe a novel surgical classification and treatment strategy for AADs.
Summary of Background Data. AADs can result from a variety of etiologies, yet no comprehensive classification has been accepted that guides treatment. Because of the rarity of the cases, however, the treatment strategy has also been debated.
Methods. During a period of 12 years, a total of 904 patients with a diagnosis of AAD were recruited from a single academic institution. According to the treatment algorithm that included preoperative evaluation using dynamic radiograph, reconstructive computed tomography, and skeletal traction test, the cases were classified into 4 types: I to IV. Types I and II were fused in the reduced position from a posterior approach. Type III, which were irreducible dislocations, were converted to reducible dislocations using a transoral atlantoaxial release, followed by a posterior fusion. Type IV presented with bony dislocations and required transoral osseous decompressions prior to posterior fusion.
Results. Four hundred seventy-two cases were classified as type I, 160 as type II, 268 as type III, and 4 cases as type IV. Follow-up was in the range of 2 to 12 years (average: 60.5 mo). Eight hundred and ninety-nine cases (99.4%) achieved a solid atlantoaxial fusion. Anatomic atlantoaxial reduction was achieved in 892 cases (98.7%), whereas 12 cases had a partial reduction. Neurological improvement was seen in 84.1% (512/609) of the patients with myelopathy. The overall complication rate was 9.1% (82/949).
Conclusion. Our surgical classification and treatment strategy for AADs was applied in those 904 cases and associated with excellent clinical results with a minimal risk of complications.
|作者单位||Peking Univ, Hosp 3, Dept Orthopaed, Beijing 100191, Peoples R China|
|Wang, Shenglin,Wang, Chao,Yan, Ming,et al. Novel Surgical Classification and Treatment Strategy for Atlantoaxial Dislocations[J]. SPINE,2013,38(21):E1348-E1356.|
|APA||Wang, Shenglin,Wang, Chao,Yan, Ming,Zhou, Haitao,&Dang, Gengting.(2013).Novel Surgical Classification and Treatment Strategy for Atlantoaxial Dislocations.SPINE,38(21),E1348-E1356.|
|MLA||Wang, Shenglin,et al."Novel Surgical Classification and Treatment Strategy for Atlantoaxial Dislocations".SPINE 38.21(2013):E1348-E1356.|