Comparison of Two Posterior Three-Point Fixation Techniques for Treating Reducible Atlantoaxial Dislocation.
Comparison of Two Posterior Three-Point Fixation Techniques for Treating Reducible Atlantoaxial Dislocation.
复制标题
两种后路三点固定技术治疗可复位寰枢椎脱位的比较。
DOI：
10.1097/brs.0000000000002754
复制
发表时间：
2019
期刊：
影响因子：
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通讯作者：
Guo Xiang
中科院分区：
文献类型：
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作者：
Zhao Wenlong;Wu Yaming;Hu Wei;Ni Bin;Guo Qunfeng;Chen Jinshui;Guo Xiang
研究设计：回顾性比较研究。目的：比较C1-C2经关节螺钉联合C1椎板钩（TAS+ C1 H）和C1-C2经关节螺钉联合改良Gallie技术（TAS+ G）治疗可复位寰枢椎脱位（AAD）的结局。背景资料总结：TAS+ C1 H和TAS+ G固定均为AAD的3点固定技术。TAS+ C1 H技术在生物力学方面与TAS+ G技术相当。方法：回顾性分析63例因AAD行TAS+ C1 H或TAS+ G固定融合术的患者资料。记录骨融合时间。采用颈痛视觉模拟评分（VASSNP）、Nurick评分、颈部僵硬度（无/轻度/重度）、患者满意度、颈部功能障碍指数（NDI）等指标对两组患者的疗效进行比较。两组Nurick量表评分均明显改善（P< 0.05），但组间比较差异无统计学意义（P> 0.05）。两组患者的VASSNP、颈部僵硬度、患者满意度、NDI差异均无统计学意义（均P> 0.05）。结论：TAS+ C1 H和TAS+ G内固定均能有效治疗可复性AAD。TAS+ C1 H比TAS+ G更安全，因为它可能降低与椎板下缆索相关的脊髓和静脉丛损伤风险。证据等级：3比较C1− C2经关节螺钉联合C1椎板钩（TAS+ C1 H）和C1− C2经关节螺钉联合改良Gallie技术（TAS+ G）治疗可复位寰枢椎脱位（AAD）的结局。它们在治疗可还原性AAD时有效，但TAS+ C1 H可能比TAS+ G更安全。
Study Design.Retrospective comparative study.Objective.To compare the outcomes of C1–C2 transarticular screw combined with C1 laminar hook (TAS+ C1H) and C1–C2 transarticular screw combined with modified Gallie technique (TAS+ G) for treating reducible atlantoaxial dislocation (AAD).Summary of Background Data.Both TAS+ C1H and TAS+ G fixation were 3-point fixation techniques for AAD. TAS+ C1H technique was comparable to TAS+ G technique in biomechanics. However, it is unknown whether it can achieve same outcomes as TAS+ G technique.Methods.Data of the 63 patients who underwent TAS+ C1H or TAS+ G fixation and fusion because of AAD were retrospectively reviewed. Bone fusion time was recorded. The outcomes evaluated by visual analog scale score for neck pain (VASSNP), Nurick scale, neck stiffness (none/mild/severe), patient satisfaction, and Neck Disability Index (NDI) were compared between two groups.Results.At the final follow-up, bone graft fusion rates were 100% in both groups (P> 0.05). Nurick scales were significantly improved in both groups (P< 0.05), but with no significant differences between groups (P> 0.05). There were no significant differences between two groups in VASSNP, neck stiffness, patient satisfaction, or NDI (all P> 0.05). There were no complications related to the surgical approach and instrumentation in either group.Conclusion.Both TAS+ C1H and TAS+ G fixation were effective in the treatment of reducible AAD. TAS+ C1H was safer than TAS+ G because it could potentially reduce the risk of spinal cord and venous plexus injury associated with sublaminar cables.Level of Evidence: 3Outcomes of C1− C2 transarticular screw combined with C1 laminar hook (TAS+ C1H) and C1− C2 transarticular screw with modified Gallie technique (TAS+ G) for treating reducible atlantoaxial dislocation (AAD) were compared. They were effective in the treatment of reducible AAD, but TAS+ C1H was potentially safer than TAS+ G.