不同横连模式后路寰枢椎椎弓根钉棒固定术治疗寰枢椎脱位的临床疗效

The clinical effects of posterior C1-C2 pedicle screw-rod fixation with different crosslink modes in the treatment of atlanto-axial dislocation

中文关键词:  寰枢椎脱位  后路内固定术  横连模式

英文关键词:Atlanto-axial dislocation  Posterior fixation  Crosslink

中文摘要:

  【摘要】 目的：探讨不同横连模式后路寰枢椎椎弓根钉棒固定术（C1-C2 pedicle screw-rod fixation，C1-C2 PSR）治疗寰枢椎脱位的临床疗效。方法：2018年1月～2019年12月采用C1-C2 PSR治疗32例寰枢椎脱位患者，所有患者术前均有四肢麻木、无力等不同程度的脊髓神经损害表现。术前均行颈椎X线片、CT及三维重建、MRI、椎动脉CTA等影像学检查明确诊断。7例采用钉尾横连（horizontal screw-screw crosslink，hS-S CL）C1-C2 PSR（A组），男4例，女3例，年龄45.57±9.05岁；12例采用棒-棒横连（horizontal rod-rod crosslink， hR-R CL）C1-C2 PSR（B组），男5例，女7例，年龄43.58±7.35岁；13例不用横连，只行C1-C2 PSR（C组），男6例，女，7例，年龄42.38±6.70岁。记录三组患者手术时间、术中出血量及并发症情况，术前和末次随访时采用日本骨科学会（Japanese Orthopaedic Association，JOA）评分法评估患者神经功能状态。术后半年及1年以上定期复查颈椎正侧位X线片、CT，评估内固定位置及骨融合情况。结果：所有患者均顺利完成手术，术中无椎动脉、脊髓及神经根损伤发生，无切口愈合不良，无心脑血管意外发生。三组患者手术时间、术中出血量、随访时间比较均无统计学差异（P＞0.05）。三组术后神经功能均有不同程度改善，末次随访时JOA评分与术前比较均有统计学差异（P＜0.05），三组JOA评分改善率无统计学差异（P＞0.05）。术后6个月、1年、2年和末次随访时植骨融合人数：A组分别为4例、5例、6例、7例，B组分别为5例、9例、10例、12例，C组分别为1例、3例、5例、10例，术后6个月、1年、2年时A组、B组与C组比较有统计学差异（P＜0.05），A组与B组比较无统计学差异（P＞0.05），末次时三组间均无统计学差异（P＞0.05）。随访期间未发生螺钉移位、松动、断裂等内固定物相关并发症。结论：不同横连模式后路寰枢椎椎弓根钉棒固定术治疗寰枢椎脱位均能取得良好的临床效果，有横连较无横连植骨融合更早，钉尾横连和棒-棒横连临床疗效相当的，但前者在术中安装时更便捷。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical effects of posterior C1-C2 pedicle screw-rod fixation(C1-C2 PSR) with different crosslink modes in treating atlanto-axial dislocation. Methods: From January 2018 to December 2019, 32 patients with atlanto-axial dislocation who had different degrees of spinal nerve damage such as limb numbness and weakness before operation were treated with C1-C2 PSR fixation. Before operation, imaging examinations including cervical X-ray, CT and three-dimensional reconstruction, MRI, vertebral artery CTA were performed to confirm the diagnosis. 7 cases were treated with horizontal screw-screw crosslink(hS-S CL) C1-C2 PSR, including 4 males and 3 females, aged 45.57±9.05 years old(group A), 12 cases were treated with horizontal rod-rod crosslink(hR-R CL) C1-C2 PSR, including 5 males and 7 females, aged 43.58±7.35 years old(group B), and 13 cases were treated with C1-C2 PSR simply, including 6 males and 7 females, aged 42.38±6.70 years old(group C). The operative time, intraoperative blood loss and complications were recorded, and Japanese Orthopaedic Association(JOA) scores were used to evaluate the neurologic status of patients before operation and at final follow-up. Anteroposterior lateral cervical X-ray and CT were performed at half a year after operation and 1 year above to assess the fixed position and bone fusion. Results: All patients underwent operation successfully without injuring vertebral artery, spinal cord, or nerve root during operation, no poor incision healing or cardiovascular or cerebrovascular accidents during follow-up. The operative time, intraoperative blood loss, and follow-up time between the three groups of patients were with no statistical differences(P>0.05). The postoperative nerve functions of the three groups of patients all improved to different extent, the differences between final follow-up JOA scores and preoperative ones were statistically significant(P<0.05), while the improvement rates of JOA scores between the three groups were not statistically different(P>0.05). For the number of bone fusion patients at 6 months, 1 year, 2 years after operation, and final follow-up: it was respectively 4 cases, 5 cases, 6 cases, and 7 cases in group A; 5 cases, 9 cases, 10 cases, and 12 cases in group B; and 1 case, 3 cases, 5 cases and 10 cases in group C. The number of bone fusion patients in group A and group B were statistically different from that in group C at 6 months, 1 year and 2 years after operation(P<0.05), while there was no statistically significant difference between group A and group B(P>0.05), and there was no statistically significant difference between the three groups at the last follow-up(P>0.05). No internal fixation-related complications such as screw displacement, loosening, or fracture occurred during follow-up. Conclusions: Posterior C1-C2 pedicle screw-rod fixation with different crosslink modes can all achieve good clinical results in the treatment of atlantoaxial dislocation. The bone graft fusion in crosslink fixation group is earlier than that in the group without crosslink fixation. The hS-S CL group has the same clinical efficacy as the hR-R CL group, but the former is more convenient for intraoperative installation.