Goel技术联合一侧寰枢外侧关节内植骨治疗寰枢椎不稳

Goel technique combined with unilateral lateral atlantoaxial intra-articular bone grafting for atlantoaxial instability

目的 评估Goel技术联合一侧寰枢外侧关节内植骨治疗寰枢椎不稳的临床疗效。方法 回顾性分析2013年1月—2017年4月中国人民解放军北部战区总医院收治的64例寰枢椎不稳患者临床资料。其中32例采用Goel技术联合一侧寰枢外侧关节内植骨治疗(A组),另32例采用单纯Goel技术治疗(B组)。术后通过影像学资料评估植骨融合情况,记录并比较2组手术并发症、内固定失败率、骨融合率、寰齿前间距(ADI)及日本骨科学会(JOA)评分。结果 所有手术顺利完成,所有患者随访>12个月,骨融合率为100%。术后所有患者症状均显著改善,未见明显并发症,无内固定失败病例。2组患者术后6、12个月ADI和JOA评分均较术前明显改善,差异有统计学意义(P<0.05);组间比较差异均无统计学意义(P>0.05)。结论 Goel技术联合一侧寰枢外侧关节内植骨治疗寰枢椎不稳的疗效与单纯Goel技术相当,不增加手术时间及术中出血量,还可减少自体骨植骨量,增加植骨面积,可以作为治疗寰枢椎不稳的补充技术。

Objective To evaluate the clinical efficacy of Goel technique combined with unilateral lateral atlantoaxial intraarticular bone grafting for atlantoaxial instability.Methods The clinical data of 64 patients with atlantoaxial instability admitted to General Hospital of Northern Theater Command of Chinese PLA from January 2013 to April 2017 were retrospectively analyzed.Among them,32 patients were treated with Goel technique combined with unilateral lateral atlantoaxial intra-articular bone grafting(group A),and 32 with Goel technique alone(group B).Bone graft fusion was evaluated by imaging data after the operation.Complications,failure rate of internal fixation,bone fusion rate,anterior atlanto-dental interval(ADI)and Japanese Orthopaedic Association(JOA)scores were recorded and compared between the 2 groups.Results All the operations were successfully completed.All the patients were followed up for>12 months.The bone fusion rate was 100%.After the operation,the symptoms of all the patients were significantly improved,no obvious complications and no internal fixation failure were found.The ADI and JOA scores of the 2 groups were significantly improved at postoperative 6 and 12 months,with a significant difference(P<0.05);and there was no significant difference between the 2 groups(P>0.05).Conclusion Goel technique combined with unilateral lateral atlantoaxial intra-articular bone grafting is as effective as Goel technique alone in the treatment of atlantoaxial instability and does not increase the operation time and intraoperative blood loss,but also reduces the amount of autogenous bone graft and increases the bone graft area.It can be used as a supplementary technique for the treatment of atlantoaxial instability.