Posterior Open Reduction and Interlaminae Compression Fusion for Os Odontoideum with Atlantoaxial Dislocation
Posterior Open Reduction and Interlaminae Compression Fusion for Os Odontoideum with Atlantoaxial Dislocation
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后路切开复位椎板间加压融合术治疗齿状骨伴寰枢椎脱位
DOI：
10.1016/j.wneu.2016.04.014
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发表时间：
2016
影响因子：
2
通讯作者：
Guo Xiang
中科院分区：
文献类型：
--
作者：
Ni Bin;Wu Lecheng;Guo Qunfeng;Lu Xuhua;Chen Fei;Guo Xiang
目的评价螺钉棒系统联合结构性髂骨移植后路切开复位椎板间压迫融合治疗牙状突继发性寰枢椎脱位的疗效。方法对24例继发于牙状突的AAD患者进行回顾性分析。所有病例均在骨牵引后部分复位。术中采用后路螺钉-棒系统进行切开复位和固定，随后椎板间压迫自体髂骨移植物进行融合。在牵引前、牵引后和术后测量改良寰牙间隙（MADI）来评估脱位程度。采用日本骨科协会（JOA）评分、Nurick量表评分、颈部疼痛视觉模拟量表评分（VASSNP）、颈部残疾指数（NDI）评分和颈部僵硬度评估功能结局。结果平均随访时间为43.0±24.0个月。所有患者均获得症状缓解和实骨融合。无器械和手术相关并发症。最终随访时，平均MADI降至2.0±0.8 mm（牵拉前9.2±1.1 mm，牵拉后6.6±0.7 mm， P< 0.001）。颈部僵硬明显缓解（P< 0.001）， JOA评分和Nurick评分所反映的脊髓功能明显改善（P< 0.001）。NDI评分和VASSNP显著降低（均p < 0.001）。结论后路螺钉-棒系统联合髂骨结构植骨术治疗牙状突继发AAD是一种安全有效的手术方法。
ObjectiveTo evaluate the outcome of posterior open reduction and interlaminae compression fusion using a screw-rod system combined with a structural iliac bone graft in the treatment of atlantoaxial dislocation (AAD) secondary to os odontoideum.MethodsA retrospective study was performed on 24 patients with AAD secondary to os odontoideum. All cases were with partial reduction after skeletal traction. Intraoperative open reduction and fixation were performed with a posterior screw-rod system, followed by interlaminae compression of an autologous iliac bone graft for fusion. The modified atlanto-dental interval (MADI) was measured to assess the degree of dislocation before traction, after traction, and postoperatively. Japanese Orthopaedic Association (JOA) score, Nurick scale score, visual analog scale score for neck pain (VASSNP), Neck Disability Index (NDI) score, and neck stiffness were used to evaluate functional outcomes.ResultsThe mean duration of follow-up was 43.0 ± 24.0 months. All patients achieved relief of symptoms and solid bone fusion. There were no complications associated with instrumentation and operation. At the final follow-up, the average MADI was reduced to 2.0 ± 0.8 mm (pretraction: 9.2 ± 1.1 mm; post-traction: 6.6 ± 0.7 mm;P< 0.001). The neck stiffness was significantly relieved (P< 0.001), and function of the spinal cord manifested by the JOA score and Nurick scale score significantly improved (allP< 0.001). The NDI score and VASSNP markedly decreased (allP< 0.001).ConclusionsIntraoperative open reduction and interlaminae compression fusion using a posterior screw-rod system combined with a structural iliac bone graft is a safe and effective procedure for AAD secondary to os odontoideum.