Long-term results of occipitothoracic fusion surgery in RA patients with destruction of the cervical spine
Long-term results of occipitothoracic fusion surgery in RA patients with destruction of the cervical spine
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DOI：
10.1097/01.bsd.0000127700.29969.e6
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发表时间：
2005-02-01
影响因子：
--
通讯作者：
Ishiguro, N
中科院分区：
文献类型：
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作者：
Matsuyama, Y;Kawakami, N;Ishiguro, N
目的：这是一项颈椎破坏的类风湿性关节炎（RA）患者枕胸融合手术结果的回顾性研究，旨在评估光环背心术前的疗效、术后结果以及与手术治疗相关的日常生活活动（ADL）问题。目前还没有关于这些问题的报道，包括手术对下椎骨的影响。方法：这项研究包括 20 名颈椎破坏的 RA 患者。所有患者均接受术前 Halo 背心，随后进行枕胸融合术，平均随访 5 年。使用改良的 Ranawat 分类对长期临床结果进行分析。 结果：在应用 Halo 之前，15 名患者的神经系统状态评估为 IIIC，5 名患者的神经系统状态评估为 IIIB。应用 Halo 后，所有患者的神经系统状态均得到改善：IIIA 级患者 12 例，IIIB 级患者 8 例。手术后，8 名 IIIB 级患者中的 6 名患者的神经系统状态没有改善，但有 2 名患者的神经系统状态改善至 IIIA。 12 例 IIIA 级患者中，6 例患者的神经系统状态改善至 II，但其他 6 例患者的神经系统状态没有改善。 14 名患者的患者满意度为优秀，3 名患者为良好，只有 3 名患者的满意度一般（1 名患者有饮酒困难，另一名患者有背痛，最后一名患者有与腰椎压缩性骨折相关的腰痛）。结论：我们对颈椎破坏的 RA 患者进行了枕胸融合手术。术前光环背心对于改善神经系统状态、一般状况和最佳矢状面对齐非常有效。与疾病遵循自然病程的患者的预后相比，使用单元棒的枕胸融合术取得了令人满意的长期临床结果。
Objective: This is a retrospective study of the outcome of occipitothoracic fusion surgery in rheumatoid arthritis (RA) patients with destruction of the cervical spine, designed to assess the efficacy of halo vest before surgery, the postoperative outcome, and the activities-of-daily living (ADL) problems associated with surgical management. There have been no reports regarding these issues, including surgical effect on subjacent vertebrae.Methods: This study included 20 RA patients with destruction of the cervical spine. All patients underwent preoperative halo vest followed by occipitothoracic fusion with an average follow-up of 5 years. The long-term clinical outcomes were analyzed using a modified Ranawat classification.Results: Before halo application, the neurologic status was assessed as IIIC in 15 patients and IIIB in 5 patients. After halo application, the neurologic status improved in all patients: IIIA in 12 patients and IIIB in 8 patients. After surgery, the neurologic status did not improve in six of the eight IIIB patients but improved to IIIA in two patients. Of the 12 IIIA patients, the neurologic status improved to II in 6 patients but did not improve in the other 6 patients. Patient satisfaction was excellent for 14 patients, good for 3 patients, and fair for only 3 patients (1 had difficulty drinking, another had back pain, and the last had low back pain associated with a compression fracture of the lumbar spine).Conclusions: We have performed occipitothoracic fusion surgery in RA patients with destruction of the cervical spine. Preoperative halo vest was very effective for improving the neurologic status, for the general condition, and for an optimal sagittal alignment. Occipitothoracic fusion using unit rods gave satisfactory long-term clinical results compared with the prognosis of patients in whom the disease follows its natural course.