双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合治疗可复性寰枢椎脱位的中长期随访报告

Medium and long term follow-up of bilateral atlantoaxial joint screw combined with atlas lamina hook fixation and bone graft fusion in reducible atlantoaxial dislocation

中文关键词:  寰枢椎脱位  经寰枢关节螺钉  寰椎椎板钩  固定  植骨融合

英文关键词:Atlantoaxial dislocation  Transarticular screw  Atlas lamina hook  Fixation  Bone graft fusion

中文摘要:

  【摘要】 目的：评估双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合治疗可复性寰枢椎脱位的中长期疗效。方法：回顾性分析85例在我院接受双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合术的可复性寰枢椎脱位患者的临床资料，其中男21例，女64例；年龄25~65岁（44±9.4岁）。寰椎爆裂性骨折19例，C1、2旋转脱位畸形16例，齿状突骨折26例，齿状突游离15例，寰椎类风湿性关节炎致寰枢椎脱位9例。通过Ranawat分级、颈椎功能障碍指数（NDI）以及颈部/枕骨下疼痛视觉模拟量表 （visual analogue scale，VAS）评分评估患者的临床疗效；在术前和末次随访时的颈椎正侧位X线片、MRI、CT三维重建等资料中，提取以下影像学数据：寰齿前间距（atlanto-dental interval，ADI）、有效椎管容积（space available for cord，SAC）、C1-2角、C2-7角，并观察植骨融合情况及颈椎稳定性。结果：所有患者均完成5年以上的随访。末次随访时24例术前存在脊髓压迫症状患者的Ranawat分级有所改善；95%的患者颈部疼痛得到缓解，VAS评分由术前7.56±1.03分下降至2.53±0.53分（P<0.05）；NDI由术前34.76±5.45分降至13.13±1.21分（P<0.05）。ADI由术前6.5±1.0mm降至2.4±0.9mm（P<0.05）；SAC由术前13.37±2.11mm增大至19.93±2.20mm（P<0.05）。手术前C1-2角为21.9°±1.2°，末次随访时为26.6°±6.9°；手术前C2-7角为19.8°±9.2°，末次随访时为15.5°±5.9°。术后6个月，81例（95.3%）患者获得良好的植骨融合，4例患者出现植骨延迟愈合。结论：双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合治疗可复性寰枢椎脱位的长期疗效优良，是一种安全、可靠的后路寰枢椎固定融合技术。

英文摘要:

  【Abstract】 Objectives: To evaluate the medium and long term surgical outcomes of bilateral atlantoaxial joint screw combined with atlas lamina hook fixation and bone graft fusion technique in patients with reducible atlanto-axial dislocation. Methods: A retrospective study was conducted to evaluate the clinical outcomes of this modified therapy in 85 patients. 21 male patients and 64 females were involved, aging 25-65(44±9.4) years old. Diagnoses included atlas fracture(19 cases), atlantoaxial rotatory dislocation(16 cases), odontoid fracture(26 cases), OS(15 cases), atlas of rheumatoid arthritis(9 cases). The clinical outcomes with Ranawat grading, neck disability index(NDI), and visual analog scale(VAS) score for neck pain were evaluation. The following imaging data were evaluated: atlanto-dental interval(ADI), space available for cord(SAC), C1-2 angle, C2-7 angle, bone fusion rate. Results: All the patients completed at least 5 years of follow-up, 95% of the cases with cervical and suboccipital pain improved in Ranawat grading after surgery. Their VAS scores for neck pain decreased by about 5 points(7.56±1.03 to 2.53±0.53, P<0.05). The mean score of NDI was reduced from preoperative 34.76±5.45 to postoperative 13.13±1.21(P<0.05). The ADI was reduced from preoperative 6.5±1.0mm to postoperative 2.4±0.9mm(P<0.05). The mean SAC was increased from preoperative 13.37±2.11mm to postoperative 19.93±2.20mm(P<0.05). The mean C1-2 angle was 21.9°±1.2° before surgery and 26.6°±6.9° at latest follow-up. The mean C2-7 angle was 19.8°±9.2° before surgery and 15.5°±5.9° at latest follow-up. Solid bone fusion was achieved in 81(95.3%) patients. Conclusions: The results of medium and long term follow-up show that bilateral transarticular screw combined with atlas laminar hook fixation and bone graft fusion is reliable and safe in the treatment of reducible atlantoaxial dislocation.