游离齿状突寰枢脱位两种后路融合术比较△

Atlantoaxial fusion versus occipitocervical fusion for os odontoideum complicated with atlantoaxial dislocation

摘要:

［目的］ 比较寰枢椎融合与颈枕融合治疗后路齿状突游离小骨合并寰枢椎脱位的临床效果。［方法］ 回顾性分析 2010 年 1 月—2015 年 12 月行后路融合术治疗的 29 例齿状突游离小骨合并寰枢椎脱位患者的临床资料。依据患者具体情况与术前医患沟通结果，22 例行寰枢椎融合 （寰枢组），7 例行颈枕融合 （颈枕组）。比较两组患者围手术期、随访和影像资料。 ［结果］两组患者均顺利完成手术，术中均无严重并发症。寰枢融合组切口长度显著小于颈枕融合组（P<0.05）。两组患者术后随访均在 6 年以上，寰枢组恢复完全负重活动显著早于颈枕组（P<0.05）。与术前相比，术后两组颈椎前屈-后伸 ROM 和左右旋转 ROM 均显著减小（P<0.05）。术后相应时间点寰枢组颈椎前屈-后伸 ROM 均显著大于颈枕组（P<0.05）。随时间推移，两组的 NDI 评分显著下降 （P<0.05），而 JOA 评分显著增加 （P<0.05）；相应时间点两组间 NDI 和 JOA 评分的差异均无统计学意义 （P> 0.05）。影像方面，与术前相比，术后两组的 C0~2角显著增大（P<0.05），而 C2~7角和 ADI 显著减小（P<0.05）。术后寰枢组的 ADI 均小于颈枕组，其中，术后 5 年时两组间差异有统计学意义（P<0.05）。［结论］两种术式均安全有效，与颈枕融合相比，寰枢融合可减小手术创伤，更好复位寰枢椎，保留更多颈椎活动度，功能恢复更好。

Abstract:

[Objective] To compare the clinical outcomes of atlantoaxial fusion versus occipitocervical fusion for os odontoideum com- plicated with atlantoaxial dislocation. [Methods] A retrospective study was done on 29 patients who underwent posterior fusion for os odon- toideum complicated with atlantoaxial dislocation from January 2010 to December 2015. According to the concrete pathology and the re- sults of preoperative doctor-patient communication, 22 patients received atlantoaxial fusion (the AA group) , while the remaining 7 patients had occipitocervical fusion performed (the OC group) . The perioperative, follow- up and imaging data were compared between the two groups. [Results] All patients in both groups were successfully operated on without serious complications, and the atlantoaxial fusion group was significantly superior to the occipitocervical group in term of incision length (P＜0.05) . All patients in both groups were followed up for more than 6 years, and the AA group resumed full weight-bearing activity significantly earlier than the OC group (P＜0.05) . Cervical flex- ion-extension ROM and left-right rotation ROM were significantly reduced in both groups after surgery compared with those preoperative- ly (P＜0.05) . The AA group proved significantly superior to the OC group in term of cervical flexion-extension ROM postoperatively (P＜ 0.05) . The NDI scores decreased significantly (P＜0.05) , while JOA score increased significantly in both groups over time (P＜0.05) , howev- er, there were no statistically significant differences in NDI and JOA scores between the two groups at any corresponding time points (P＞ 0.05) . Radiographically, the C_0~2 angle increased significantly (P＜0.05) , whereas the C_2~7 angle and anterior atlantodental interval (ADI) de- creased significantly postoperatively compared with those preoperatively in both groups (P＜0.05) . The AA group got less ADI than the OC group postoperatively, which proved statistically significant at 5 years after surgery (P＜0.05) . [Conclusion] Both atlantoaxial fusion and oc- cipitocervical fusion are safe and effective for this disorder. By comparison, the atlantoaxial fusion takes advantages of reducing surgical trauma, improving atlantoaxial reduction, retaining more cervical motion, and getting better functional recovery.