文章简介

出版社:Eur Spine J.

作   者:Ding X, Abumi K, Ito M, Sudo H, Takahata M, Nagahama K, Iwata A

编   号:10.1007/s00586-012-2324-x.

年   份:2012    点击量:1013

文章摘要 全文翻译

Purpose

        To evaluate the effectiveness of posterior occipitocervical reconstruction using the anchors of cervical pedicle screws and plate-rod systems for patients with congenital osseous anomalies at the craniocervical junction.

目的

        评估使用颈椎弓根螺钉和板-棒系统对颅颈交界区先天性骨畸形的患者进行后路枕颈重建的疗效。

Methods

        Twenty patients with congenital osseous lesions who underwent posterior occipitocervical fusion using the anchors of cervical pedicle screws and plate-rod systems for reduction and fixation from 1996 to 2009 were reviewed. The lesions included os odontoideum, occipitalization of the atlas, congenital C2–3 fusion, congenital atlantoaxial subluxation, congenital basilar invagination and combined anomalies. The clinical assessment and the measurements of the images were performed preoperatively, postoperatively and at most recent follow-up.

方法

        回顾1996到2009年20例经后路枕颈融合的先天性骨病变的患者,他们使用椎弓根螺钉和板-棒系统进行复位及固定。病变包括齿状突游离小骨、寰椎枕骨化、先天性C2-3融合、先天性寰枢椎半脱位、先天性颅底凹陷症及混合畸形。在术前、术后及最近随访时对患者进行临床评估及影像学测定。

Results

        The combined deformity of flexion of the occipitoatlantoaxial complex and invagination of the odontoid process associated with congenital osseous lesions at the craniocervical junction was corrected by application of combined forces of extension and distraction between the occiput and the cervical pedicle screws. Preoperative myelopathy improved in 94.7 % patients. The mean Ranawat value, Redlund-Johnnell value, atlantodental distance, occiput (O)–C2 angle, and C2–C7 lordosis angle improved postoperatively and was sustained at most recent follow-up. The mean cervicomedullary angle improved from 129.3°preoperatively to 153.3°postoperatively. The mean range of motion at the lower adjacent motion segment remained unchanged at most recent follow-up. The fusion rate was 95 %.

结果

        在仰伸作用力下使用枕部和颈椎椎弓根螺钉并撑开,来矫正合并枕寰枢复合体屈曲积畸形及齿状突内陷畸形,后者与颅颈交界区先天性骨病变有关。94.7%的患者脊髓病变改善。术后平均Ranawat值、Redlund-Johnell值、寰齿间距、枕骨(O)–C2角以及C2–C7脊柱前凸角得到改善且在最近随访时保持不变。平均颈髓角从术前129.3°增至术后153.3°。较低的相邻运动节段的平均活动范围在最近随访时保持不变。融合率为95%。

Conclusions

        The results of the present study indicate that posterior occipitocervical reconstruction using the anchors of cervical pedicle screws and plate-rod systems is an effective technique for treatment of deformities and/or instability caused by congenital osseous anomalies at the craniocervical junction.

结论

        目前研究结果表明使用颈椎弓根螺钉和板-棒系统进行后路枕颈重建是治疗颅颈交界区先天性骨畸形所致的畸形和/或不稳的一种有效方法。