后路寰枢椎经关节螺钉结合寰椎椎板钩与寰枢椎椎弓根螺钉固定融合治疗寰枢椎脱位的疗效比较

Comparison of outcomes in the treatment of reducible atlantoaxial dislocation by C1-2 transarticular screws combined with C1 laminar hook versus C1 lateral mass with C2 pedicle screws

目的:比较后路寰枢椎经关节螺钉结合寰枢椎板钩固定融合与寰枢椎椎弓根螺钉固定融合治疗可复性寰枢椎脱位的临床疗效。方法:回顾性分析2006年6月~2012年3月行寰枢椎经关节螺钉结合寰椎椎板钩固定融合治疗的74例可复性寰枢椎脱位患者(钉钩组)的临床资料,以同时期相同纳入标准采用后路寰枢椎椎弓根螺钉固定融合治疗的63例患者(钉棒组)作为对照。记录术前疼痛视觉模拟量表(VAS)评分、脊髓功能(ASIA分级)、颈部僵硬度、颈椎功能障碍指数(NDI)、术中出血量、手术时间。以末次随访时植骨融合率、VAS评分、ASIA分级、NDI、颈部僵硬度及患者满意度评价治疗效果,并比较两组间的临床疗效。结果:两组患者的年龄、性别比和术前VAS评分、NDI、ASIA分级差异均无统计学意义(P>0.05),具有可比性。钉钩组随访时间为76.3±14.0(48~110)个月,平均手术时间为126.1±8.6min,平均术中出血量为207.8±34.2ml,植骨融合率为100%,平均融合时间为4.6±0.9个月;钉棒组随访时间为72.0±12.0(48~96)个月、平均手术时间为129.8±7.9min,平均术中出血量为225.8±30.0ml,植骨融合率为98%,平均融合时间为4.8±1.2个月。两组随访时间、手术时间、植骨融合率和融合时间的差异均无统计学意义(P>0.05),钉钩组的平均术中出血量与钉棒组比较差异有统计学意义(P<0.05)。两组患者末次随访时VAS评分、NDI和颈部僵硬度均较术前降低(P<0.05)。有神经症状的患者,钉钩组的49例与钉棒组的37例末次随访时ASIA分级较术前提高1~2级。末次随访时,VAS评分、ASIA分级、颈部僵硬度、患者满意度及NDI两组间差异均无统计学意义(P>0.05)。结论:后路寰枢椎经关节螺钉结合寰椎椎板钩固定融合与寰枢椎椎弓根螺钉固定融合治疗可复性寰枢椎脱位均能达到满意的临床疗效,但前者术中出血量更少。

Objectives： To compare the clinical curative effects of C1-2 transarticular screws combined with C1 laminar hook （screw-hook constructs） versus C1 lateral mass with C2 pedicle screws（screw-rod constructs） for the treatment of reducible atlantoaxial dislocation. Methods： From June 2006 to March 2012, 74 patients with reducible atlantoaxial dislocation treated with atlantoaxial fixation by C1-2 screw-hook constructs were reviewed retrospectively, and 63 patients treated by C1-2 screw-rod constructs were as control. The visual analog scale（VAS） score, ASIA impairment scale, neck stiffness, neck disability index（NDI）, blood loss during operation and operation time were reviewed. At the last follow-up, the clinical efficacy between the two groups were compared with regard to bone fusion rate, VAS score, ASIA impairment scale, NDI, neck stiff- ness and patient satisfaction. Results： There was no statistical difference in age, sex ratio, preoperative VAS score, NDI, ASIA impairment scale or follow-up period between the two groups（P〉0.05）. The postoperative follow-up period of screw-hook constructs group was 76.3±14.0（48-110） months, the average operation time was 126.1±8.6rain, blood loss was 207.8± 34.2m1, bone fusion rate was 100%, the average fusion time was 4.6±0.9 months. The postoperative follow-up period of screw-rod constructs group was 72.0±12.0 （48-96） months, the average operation time was 129.8±7.9min, blood loss was 225.8±30.0ml, bone fusion rate was 98%, the average fusion time was 4.8±1.2 months. There was no statistical difference in the follow-up time, average operation time, bone graft fusion rate or average fusion time between the two groups（P〉0.05）. There was a significant statistical difference in blood loss between the two groups （P〈0.05）. The ASIA impairment scale of 49 cases with neurological symptoms in screw-hook constructs group was improved by 1-2 grade, 37 eases in screw-rod constructs group with the same result. While VAS score, NDI and neck stiffness were decreased at the last follow-up in each group （P〈0.05）. There was no significant difference between the two groups with respect to VAS score, ASIA impairment scale, neck stiffness, patient satisfaction or NDI at the last follow-up （P〉0.05）. Conclusions： Both screw-hook constructs and screw-rod constructs can achieve satisfactory clinical efficacy for reducible atlantoaxial dislocation, but screw-hook constructs group has less blood loss.