Abstract:

Objective To investigate the clinical efficacy and safety of 3D microscopy ⁃assisted posterior pedicle screw fixation in the treatment of atlantoaxial fracture and dislocation. Methods 36 patients with upper cervical fracture and dislocation who had treated in our hospital from January 2015 to June 2020 were analyzed retrospectively. 15 patients received pedicle screw fixation assisted by 3D microscopy（3D group），and 21 received pedicle screw fixation assisted by ordinary microscopy（OM group）. The indexes of perioperative period，clinical efficacy and safety were compared between the two groups. Results The surgical duration was（162.33 tioncy and in the 3D group and（187.59 ± 29.45）min in the OM group，and it was significantly shorter in the 3D group than in the OM group（P < 0.05）. There were no significant differences in other perioperative indexes between the two groups（P > 0.05）. After operation，the neck pain was significantly relieved in all the patients and the neurological symptoms were alleviated at varying degrees（P < 0.01）. There were significant differences in the scores on VAS and JOA between the preoperative baselines and postoperative year one，but there was no significant difference between the two groups（P > 0.05）. A total of 68 upper cervical pedicle screws were placed in the 3D group，62 of which were in grades 0 andⅠ，with a satisfactory rate of 91.18%. In the OM group，there were 96 upper cervical pedicle screws，84 of which were in grades 0 andⅠ，with a satisfactory rate of 87.50%. There was no significant difference in the satisfactory rate between the two groups（P > 0.05）. No complications such as nerve injury，dural rupture，and vertebral artery injury were found in both groups. The incidence of surgery⁃related complications was 13.33% in the 3D group and 23.81% in the OM group. There was no statistical difference in the incidence of com⁃ plications between the two groups（P > 0.05）. Conclusions Both 3D and ordinary microscopy ⁃ assisted pediclescrew fixation are effective and safe in the treatment of upper cervical fracture and dislocation，but the surgical duration is shorter under 3D microscopy and the incidence of complications may be lower.

Key words:

3D microscope, pedicle screw, atlantoaxial, fracture, dislocation