椎弓根螺钉内固定结合功能锻炼治疗类风湿性关节炎寰枢椎脱位疗效观察

Clinical effect of pedicle screw internal fixation combined with functional exercise for the treatment of atlanto-axial dislocation in rheumatoid arthritis

目的观察椎弓根螺钉内固定结合功能锻炼治疗类风湿性关节炎寰枢椎脱位的疗效。方法回顾性分析2016年2月至2019年2月西北大学附属医院(西安市第三医院)收治的39例类风湿性关节炎寰枢椎脱位患者的临床资料,所有患者均采用椎弓根螺钉内固定结合功能锻炼治疗。随访12个月,采用Odom临床疗效评定标准比较患者术前、术后12个月时的恢复情况;采用脊髓型颈椎病JOA评分[改良17(-2)法]、VAS疼痛评分评价患者术前、术后1周、末次随访时的脊髓功能以及疼痛情况;采用生活质量(SF-36)量表评估患者术前、术后12个月时的生活质量;观察患者植骨融合情况以及并发症发生情况。结果39例患者术后12个月经Odom评价关节恢复为优者32例(82.05%),良者5例(12.82%),术后恢复优良率为94.87%;术后、末次随访时的JOA、VAS评分与术前相比,JOA评分高于术前,VAS评分低于术前,差异均具有统计学意义(P<0.05);所有患者术后12个月时SF-36各项目评分明显高于术前,差异均具有统计学意义(P<0.05);所有患者在术后12个月随访期间颈部疼痛及神经症状均有明显改善,均未发现断钉及复发脱位现象;术后3个月复查时,有12例植骨融合(融合率为30.77%),术后6个月复查时,有32例植骨融合(融合率为82.05%),术后12个月复查时,有39例植骨均融合(融合率为100.00%)。结论椎弓根螺钉内固定结合功能锻炼治疗类风湿性关节炎寰枢椎脱位能够在直视下置钉,短节段固定可靠,融合率高,有利于重建寰枢椎序列,减少并发症,提升生活质量。

Objective To explore the effect of pedicle screw internal fixation combined with functional exercise in the treatment of atlanto-axial dislocation in rheumatoid arthritis.Methods The clinical data of 39 patients with atlanto-axial dislocation in rheumatoid arthritis admitted to Xi'an Third Hospital/the Affiliated Hospital of Northwest University from February 2016 to February 2019 was retrospectively analyzed.All patients were treated with pedicle screw internal fixation combined with functional exercise therapy,and then followed up for 12 months.The Odom clinical efficacy evaluation standard was used to compare the patients'joint recovery before and 12 months after the operation;JOA score of cervical spondylotic myelopathy(modified 17(-2)method)and VAS scale were used to evaluate the spinal cord function and pain before operation,at 1 week after surgery,and at the last follow-up;SF-36 scale was used to assess the changes in the quality of life of patients before and 12 months after surgery;the patient's bone graft fusion and complications occurred were observed.Results Twelve months after operation,the joint recovery evaluated by Odom standard was excellent in 32 cases(82.05%,32/39),good in 5 cases(12.82%,5/39),with the postoperative recovery rate of 94.87%.Compared with the preoperative scores the JOA scores at 1 week after operation and at the last follow-up were higher than those before the operation,and the VAS scores were lower than those before the operation,with statistically significant difference(P<0.05).The scores of all SF-36 items at 12 months after surgery were significantly higher than those before surgery,and the differences were statistically significant(P<0.05).All patients had significant improvement in neck pain and neurological symptoms during the 12-month follow-up period after surgery,and no broken nails or recurrent dislocation were found.There were 12 cases of bone graft fusion at 3 months after surgery(the fusion rate was 30.77%),32 cases of bone graft fusion at 6 months after surgery(82.05%),and 39 cases of bone graft fusion at 12 months after surgery(100.00%).Conclusion Pedicle screw internal fixation combined with functional exercise for the treatment of atlanto-axial dislocation in rheumatoid arthritis can operate under direct vision,and brings reliable short segment fixation and high fusion rate,which is conducive to reconstructing the atlantoaxial sequence,reducing complications,and improving the quality of life.