枕颈融合术中联合两种测量枕颈角方法调控枕颈固定角度的临床应用

The application of the combination of POCA and TOCA angles for management of occipitocervical angle in occipitocervical fusion

目的观察枕颈融合术中应用综合策略对固定枕颈角及临床疗效的影响。方法收集2013年5月~2016年3月我科采用综合策略(后枕颈角和Takami'枕颈角)完成后路枕颈融合术的13例患者资料,男3例,女10例;年龄31~60岁(平均42.9岁)。50例年龄20~60岁健康志愿者(男女各半)获得正常人群后枕颈角和Takami'枕颈角的数据;术中基于上述数据调整固定角度。记录患者术前和术中枕颈角度的变化,及手术相关并发症发生情况。术后随访,采用日本矫形外科协会(Japanese Orthopaedic Association,JOA)和VAS评分评估临床疗效;X线平片评价植骨融合情况,及各随访时间点枕颈角和下颈椎曲度变化情况。结果术前6例患者Takami'枕颈角为非正常值,其中4例患者后枕颈角及Takami'枕颈角均为非正常值。13例患者手术均顺利完成,术后即刻后枕颈角及Takami'枕颈角都在正常范围之内,无严重手术相关并发症发生。患者术后随访12~48月(平均27.4±15.1月),术后患者枕颈部疼痛及神经功能获得显著改善;末次随访,VAS评分由术前6.4±0.8分降至2.9±0.6分;JOA评分由术前12.9±2.3分改善至15.3±0.9分。术后各随访点枕颈角及下颈椎曲度无显著变化(P>0.05);至末次随访,13例患者枕颈部骨性融合,无内固定物松动、断裂。结论枕颈融合术中应用综合策略有助于选择合理的固定角度并避免枕颈角度不佳所致各种并发症,从而获得满意的手术疗效。

Objective To evaluate the application of a comprehensive strategy for proper fixed angle in occipitocervical fusion. Methods We reviewed the data and charts of 13 consecutive patients who underwent posterior occipitocervical fusions between May 2013 and March 2016, and all operations were performed with a comprehensive strategy consisting of posterior occipitocervical angle（POCA） and Takami＇ occipitocervical angle（TOCA）. All patients were diagnosed with occipitocervical instability basilar invagination with atlantoaxial dislocation. There were 3 males and 10 males, with an average age of 42.9 years. The comprehensive strategy basing on data of POCA and TOCA measured from 50 healthy subjects without cervical disease. The paraoperative complications were recorded, radiological data of POCA and TOCA were also collected before and during operations. The Japanese Orthopaedic Association（JOA, maximum value： 17）and the visual analog scale（VAS, 0-10） were used to evaluate the clinical outcome. Radiological data of occipitocervical angle and subaxial cervical spine was collected and assessed after operation, and at final follow-up. Results All 13 operations were performed uneventfully. After operation, both the POCA and TOCA angles of 13 patients were within the normal ranges. No severe postoperative complications occurred. The mean follow-up were 27.4±15.1 months（range,12 to 48 months）. Both the JOA and VAS scores improved significantly after operation. The values of POCA, TOCA and subaxial cervical alignment did not show significant changes during follow-up period（P0.05）. Conclusion The comprehensive strategy basing on data of POCA and TOCA measured from 50 healthy subjects might help provide proper fixed angle and good clinical outcome in patients undergoing posterior occipitocervical fusion.