Comparison of Outcomes Between C1-C2 Screw-Hook Fixation and C1-C2 Screw-Rod Fixation for Treating Reducible Atlantoaxial Dislocation
Comparison of Outcomes Between C1-C2 Screw-Hook Fixation and C1-C2 Screw-Rod Fixation for Treating Reducible Atlantoaxial Dislocation
复制标题
C1-C2螺钉钩固定与C1-C2螺钉棒固定治疗复位性寰枢椎脱位的疗效比较
DOI：
10.1097/brs.0000000000002152
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发表时间：
2017-10-15
期刊：
影响因子：
3
通讯作者：
Xie, Ning
中科院分区：
文献类型：
--
作者：
Ni, Bin;Zhao, Wenlong;Xie, Ning
研究设计回顾性比较研究。比较C1-C2跨关节螺钉联合C1板层钩（TAS+C1H）固定和C1跨关节外侧肿块螺钉联合C2椎弓根螺钉（C1TLMS+C2PS）固定治疗可复性寰枢脱位（AAD）的疗效。在生物力学方面，TAS+C1H与采用后方接线技术的TAS相当，而优于C1侧块螺钉联合C2椎弓根螺钉（C1LMS+C2PS）。然而，很少有研究分析TAS+C1H技术与改良C1LMS+C2PS技术（C1TLMS+C2PS）治疗AAD的疗效差异。回顾性分析了 30 例采用 TAS +C1H 固定术治疗的可复性 AAD 患者和另外 30 例采用 C1TLMS+C2PS 固定术治疗的患者的数据。记录了骨融合时间。通过美国脊柱损伤协会损伤量表、颈部疼痛视觉模拟量表评分、颈部僵硬（无/轻度/重度）、患者满意度和颈部残疾指数（NDI）对两组患者的治疗效果进行比较。两组患者均未出现与手术方法和器械相关的并发症。在最终随访中，TAS+C1H固定组和C1TLMS+C2PS固定组的植骨融合率均为100%（P>0.05）。根据美国脊柱损伤协会损伤量表评估，两组患者的神经功能状况均有显著改善（P 0.05）。C1TLMS+C2PS固定与TAS+C1H固定治疗可复性AAD的融合率和功能疗效相当。为降低椎动脉损伤的风险，术前应进行计算机断层扫描和重建，以分析椎动脉走向和C1-C2解剖结构。
Study Design. Retrospective comparative study.Objective. To compare the outcomes of C1-C2 transarticular screw with C1 laminar hook (TAS+C1H) fixation and C1 transarch lateral mass screw with C2 pedicle screw (C1TLMS+C2PS) fixation in the treatment of reducible atlantoaxial dislocation (AAD).Summary of Background Data. TAS+C1H is comparable to TAS with posterior wiring techniques and superior to C1 lateral mass screw combined with C2 pedicle screw (C1LMS+C2PS) in biomechanics. There were, however, few studies analyzing the differences in outcomes between TAS+C1H technique and modified C1LMS+C2PS technique (C1TLMS+C2PS) for treating AAD.Methods. Data of 30 patients with reducible AAD treated by TAS +C1H fixation and another 30 cases treated by C1TLMS+C2PS fixation were retrospectively analyzed. Bone fusion time was recorded. The outcomes evaluated by American Spinal Injury Association impairment scale, visual analog scale score for neck pain, neck stiffness (none/mild/severe), patient satisfaction, and Neck Disability Index (NDI) were compared between two groups.Results. There were no complications related to the surgical approach and instrumentation in either group. At the final follow-up, bone graft fusion rates were 100% in both the TAS+C1H fixation group and the C1TLMS+C2PS fixation group (P>0.05). The neurological status evaluated by American Spinal Injury Association impairment scale were greatly improved in both screw-hook group (P 0.05).Conclusion. C1TLMS+C2PS fixation was comparable to TAS+C1H fixation in fusion rate and functional outcomes for treating reducible AAD. To reduce the risk of vertebral artery injury, computed tomography scan, and reconstruction should be done to analyze vertebral artery course and C1-C2 anatomic structures before operation.