寰枢椎脱位不同后路融合术对相邻节段退变的影响

The influence of different posterior fusion procedures on adjacent-segment degeneration in patients with atlantoaxial dislocation

中文关键词:  寰枢椎脱位  寰枢融合术  枕颈融合术  相邻节段退变

英文关键词:Atlantoaxial dislocation  Atlantoaxial fusion  Occipitocervical fusion  Adjacent-segment degenera?鄄tion

中文摘要:

  【摘要】 目的：观察寰枢椎脱位不同后路融合术对其相邻节段退变的影响。方法：2000年6月~2010年6月共纳入43例寰枢椎脱位患者，按照后路融合方式分为寰枢融合组（23例）和枕颈融合组（20例）。记录两组患者末次随访时相邻节段C2-3半脱位（SAS）的出现率及活动度，术前及末次随访时的C2/3椎间隙高度与C3椎体高度的比值（S值）及C2-7矢状位角度，并进行统计学比较。结果：两组术前的JOA评分、S值及C2-7矢状位角度差异均无统计学意义（P＞0.05）。寰枢融合组随访时间为7.40±1.51年，枕颈融合组随访时间为6.97±1.32年，组间比较无统计学差异（P＞0.05）。23例行寰枢融合术者出现2例SAS（8.7％），20例行枕颈融合术者出现7例SAS（35％），差异有统计学意义（P<0.05）。寰枢融合组和枕颈融合组末次随访时S值均较术前减小，枕颈融合组S值减小更明显，两组之间差异有统计学意义（P<0.05）。末次随访时，寰枢融合组及枕颈融合组C2-3活动度分别为3.78°±3.01°和1.45°±1.72°，两组比较有统计学差异（P<0.05）。寰枢融合组C2-7矢状位角度由术前的15.16°±5.66°降至末次随访的12.40°±9.34°，枕颈融合组由术前的15.54°±6.54°降至末次随访的-0.22°±12.45°，两组末次随访的C2-7矢状位角度有统计学差异（P<0.05）。结论：寰枢融合术比枕颈融合术的颈椎相邻节段退变发生率低、程度轻，临床上应严格掌握手术指征，不要轻易行枕颈融合。

英文摘要:

  【Abstract】 Objectives: To investigate the influence of two different posterior fusion procedures on adjacent-segment degeneration in patients with atlantoaxial dislocation. Methods: From June 2000 to June 2010, a total of 43 patients with atlantoaxial dislocation undergoing fusion were reviewed retrospectively. According to the fusion methods, all patients were divided into atlantoaxial fusion group(23 cases) and occipitocervial fusion group(20 cases). Sub-axial subluxation(SAS) and range of motion(ROM) of C2-3 was measured during final follow-up. Standard ratio of height of cervical intervertebral space to height of inferior vertebral body(S value) and sagittal angles in each group were measured at preoperation and during final follow-up. The results were compared statistically. Results: The preoperative JOA score, S value and C2-7 sagittal angles of the two groups had no significant difference(P＞0.05). The mean follow-up time of the two groups was 7.40±1.51 and 6.97±1.32 years respectively, which showed no significant difference between two groups(P＞0.05). The incidence of SAS was 8.7% for atlantoaxial fusion group and 35% for occipitocervical fusion group, which showed significant difference between two groups(P<0.05). The S value of C2-3 was smaller at postoperative final follow-up than preoperation in both groups, but the value in occipitocervical fusion group decreased significantly than in atlantoaxial fusion group(P<0.05). The ROM of C2-3 in the atlantoaxial fusion group and occipitocervical fusion group was 3.78°±3.01° and 1.45°±1.72° at final follow-up respectively, which showed significant difference between two groups(P<0.05). C2-7 sagittal angles in atlantoaxial fusion group decreased from 15.16°±5.66° to 12.40°±9.34°(P<0.05), C2-7 sagittal angles in occipitocervical fusion group decreased from 15.54°±6.54° to -0.22°±12.45°(P<0.05), which showed significant difference between two groups(P<0.05). Conclusions: Compared with occipitocervical fusion, atlantoaxial fusion appears less incidence of degeneration of lower adjacent segments. It is strongly recommended that the occipitocervical fusion should be determined carefully.