术中斜坡-枢椎角在上颈椎不稳定患者后路手术中的临床应用

Clinical effect of clivo-axial angle in posterior approach for patients with unstable upper cervical spine

目的 研究术中斜坡-枢椎角(CAA)在上颈椎不稳定患者后路手术中的临床应用效果.方法 选取2014年10月至2016年3月治疗的上颈椎不稳定后入路手术患者21例,按照术中是否减压分为减压组11例,未减压组10例.术中复位前后采用移动式三维C形臂X线测量CAA,判断颈椎后路手术复位固定植骨融合手术脊髓压迫缓解情况,指导复位.术前及术后3个月CT测量CAA,MRI测量延髓-脊髓角(CMA);术后6个月采用日本骨科协会(JOA)评分评价神经功能恢复情况.结果 所有患者均获得6~12个月随访,两组患者术后3个月 CMA(156.3 ± 3.6)°与(155.9 ± 2.7)°和 CAA(154.3 ±5.1)°与(151.3±4.7)°均较术前[CMA:(131.5±0.6)°与(131.1±0.5)°;CAA:(133.2±1.7)°与(132.4 ±1.2)°明显改善,差异有统计学意义(CMA:t=-21.81,P=0.00,t=-28.54,P=0.00;CAA:t=-12.44,P=0.00,t =-11.68,P=0.00);术中复位后CAA(152.3±1.3)°与(153.6±1.2)°较复位前(131.1±1.9)°与(132.4±1.5)°明显改善,差异具有统计学意义(t=-30.09,P<0.05,t=-35.93,P<0.05).术后6个月时的两组的JOA评分(9.8±1.3)分与(10.3±1.7)分均较术前(7.1±0.7)分与(7.6±1.1)分明显改善,差异有统计学意义(t=6.01,P<0.05,t=4.36,P<0.05).所有患者均未出现固定失效、感染、脊髓损伤、椎动脉损伤等并发症.结论 对于上颈椎畸形不稳定患者,术中三维C形臂扫描测量CAA判断脊髓受压的缓解效果,指导复位,简便可行,临床效果满意.

Objective To investigate the clinical effect of clivo-axial angle(CAA)in the posterior approach for patients with unstable upper cervical spine.Methods Twenty-one patients with unstable upper cervical spine treated with posterior approach surgery from October 2014 to March 2016 were included in this study,and the patients were divided into the decompression group(11 cases)and the non-decompression group (10 cases)according to whether the intraoperative decompression was included.The clivo-axial angle(CAA) were measured by mobile three-dimensional before and after the surgery in order to estimate the reduction of spinal cord compression effect after the posterior cervical surgery combined with the reduction,fixation and bone graft fusion,then to guide the restoration.CT was used to measure the CAA and MR was used to measure the cervico-medullary angle(CMA)before operation and 3 months after operation.Japanese Orthopedic Association (JOA)scores was used to evaluate the neurological function 6 months after operation.Results All patients were followed up for 6-12 months.CMA((156.3±3.6°)vs.(155.9±2.7°))and CAA((154.3±5.1°)vs. (151.3±4.7°))of the decompression group and the non-decompression group at 3 months after surgery were improved significantly compared with those collected before the surgery(CMA:(131.5 ± 0.6°)vs.(131.1 ±0.5°);CAA:(133.2 ± 1.7°)vs.(132.4 ± 1.2°)),the differences were statistically significant(CMA: t=-21.81,P=0.00 vs.t=-28.54,P=0.00;CAA: t=-12.44,P=0.00 vs.t=-11.68,P=0.00).After operation,CAA((152.3 ± 1.3)vs.(132.6 ± 1.5))was significantly improved,compared with that before reduction((131.1±1.9)vs.(132.4±1.5°))(t=-30.09,P=0.00 vs.t=-35.93,P=0.00).JOA scores of the two groups at 6 months after operation((9.8±1.3)points vs.(10.3±1.7)points)were significantly lower than those before the surgery((7.1 ± 0.7)points vs.(7.6 ± 1.1)points),the differences were statistically significant(t=6.01,P=0.00 vs.t=4.36,P=0.00).No complications such as fixed failure,infection,spinal cord injury and vertebral artery injury were found in all patients.Conclusion For patients with upper cervical spine instability,the usage of intraoperative three-dimensional C arm scanning in CAA measurement to determine the effect of spinal cord compression can guide the reduction,simple and feasible,the clinical effect is satisfactory.