Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion
Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion
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Cotrel Dubousset 器械用于枕颈胸融合术
DOI：
10.1007/s00586-002-0392-z
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发表时间：
2002
影响因子：
2.8
通讯作者：
R. Hedlund
中科院分区：
文献类型：
--
作者：
T. Fagerström;R. Hedlund
目前有多种颈椎固定技术可供选择，但均具有固有的局限性和风险。鉴于布线和螺钉固定的缺点，两者都以良好的骨质量为稳定前提，因此需要一种稳定且安全且也可用于骨质疏松骨的固定系统。本回顾性研究的目的是评估基于层下钩的颈椎 Cotrel Dubousset 器械 (CCDI) 的实用性和安全性。该材料包括 60 名连续患者，其中 28 名男性和 32 名女性，平均年龄 57.3 岁（范围 17-84 岁），接受 CCDI 手术。诊断为外伤17例，类风湿性关节炎16例，肿瘤20例，杂项7例。材料中以严重病理为主，其中 17 名患者 (28%) 存在神经功能障碍。记录术前和术后的并发症、主观结果和弗兰克尔神经状态分类。患者疗效评估为优46%，良34%，一般10%，差10%。医生的评估结果相似：56% 优秀，27% 良好，10% 尚可，7% 较差。 2 名患者的 Frankel 等级提高了 2 级，7 名患者的 Frankel 等级提高了 1 级，47 名患者的 Frankel 等级与术前相同。两名患者恶化 1 级 Frankel，一名患者恶化 3 级，一名患者恶化 4 级 Frankel。除了10%的深部伤口感染率外，几乎没有并发症，没有证据表明椎管内的钩子造成神经损伤。本研究结果表明，颈椎CDI系统可以安全地用于稳定颈椎固定，无需外部支撑，用于严重的颈椎病变。
There are today several techniques available for cervical fixation – all with inherent limitations and risks. In view of the drawbacks of wiring and screw fixation, which both presuppose good bone quality for stabilization, there is a need for a stable and safe fixation system that can also be used in osteoporotic bone. The objective of the present retrospective study was to assess the usefulness and safety of Cervical Cotrel Dubousset Instrumentation (CCDI), based on sublaminar hooks. The material comprises 60 consecutive patients, 28 men and 32 women, with a mean age of 57.3 years (range 17–84 years), operated on with CCDI. The diagnosis was trauma in 17 patients, rheumatoid arthritis in 16 patients, tumor in 20 patients and miscellaneous diagnoses in 7 patients. The material was dominated by severe pathologies, with neurological impairment in 17 patients (28%). Complications, subjective outcome and Frankel classification of neurological status pre- and postoperatively was documented. The patient outcome evaluation was excellent in 46%, good in 34%, fair in 10%, and poor in 10%. The physician's assessment was similar: 56% excellent, 27% good, 10% fair and 7% poor. Two patients improved by two Frankel grades, 7 by one and 47 patients had the same Frankel grade as preoperatively. Two patients deteriorated by one Frankel grade, one by three grades and one patient by four Frankel grades. Except for a 10% deep wound infection rate, there were few complications, with no evidence of neurological injury from the hooks in the spinal canal. The results of this study show that the cervical CDI system can be safely used for stable cervical fixation without need for external support in severe pathologies of the cervical spine.