Goel技术联合一侧寰枢外侧关节内植骨重建寰枢椎椎管内外哑铃形肿瘤切除后寰枢椎稳定性

目的评估Goel技术联合一侧寰枢外侧关节内植骨对寰枢椎椎管内外哑铃形肿瘤切除后寰枢椎稳定性的重建作用。方法回顾性分析2010年1月—2017年12月中国人民解放军北部战区总医院收治的26例寰枢椎椎管内外哑铃形肿瘤切除后行寰枢椎稳定性重建患者的临床资料。所有患者均行双侧寰椎侧块螺钉、枢椎椎弓根螺钉固定,并于肿瘤侧行寰枢外侧关节内植骨,对侧行后方植骨。术后通过影像学资料评估其融合情况,并对手术并发症发生情况、内固定失败率、骨融合率、术前及术后寰齿前间距(ADI)和日本骨科学会(JOA)评分进行分析。结果所有手术顺利完成,所有患者随访 6个月,未发生明显手术并发症,骨融合率为100%,无内固定失败病例。术后所有患者症状均显著改善,术后JOA评分明显优于术前,差异有统计学意义(P 0.05)。手术前后ADI无明显变化。结论 Goel技术联合一侧寰枢外侧关节内植骨重建寰枢椎椎管内外哑铃形肿瘤切除后寰枢椎稳定性,可获得满意的融合率,并且获得寰枢椎各个方向运动的生物力学稳定性。

Reconstruction of atlantoaxial stability after resection of atlantoaxial intra-extra spinal canal dumbbellshaped tumors by Goel technique combined with unilateral atlantoaxial lateral articular bone grafting

Objective To evaluate the clinical effect of Goel technique combined with unilateral atlantoaxial lateral articular bone grafting on reconstruction of atlantoaxial stability after resection of atlantoaxial intra-extra spinal canal dumbbellshaped tumors. Methods The clinical data of 26 patients with atlantoaxial intra-extra spinal canal dumbbell-shaped tumors admitted to General Hospital of Northern Theater Command of Chinese PLA from January 2010 to December 2017 were analyzed retrospectively. All the patients underwent bilateral atlantal lateral mass screw and axial pedicle screw fixation, lateral atlantoaxial joint bone grafting on the tumor side, and posterior bone grafting on the other side. Postoperative imaging data were used to evaluate the fusion, and the incidence of complications, failure rate of internal fixation, bone fusion rate, preoperative and postoperative anterior atlanto-dental interval(ADI) and Japanese Orthopaedic Association(JOA) score were analyzed. Results All the operations were successfully completed. All the patients were followed up for more than 6 months. No obvious complications occurred. Bone fusion rate was 100%. No internal fixation failure occurred. The symptoms of all the patients improved significantly at post-operation, and the JOA score after operation was significantly better than that before operation, and the difference was statistically significant(P<0.05). There was no significant change in ADI before and after the operation. Conclusion Goel technique combined with unilateral atlantoaxial lateral articular bone grafting to reconstruct atlantoaxial stability after resection of atlantoaxial intra-extra spinal canal dumbbell-shaped tumors can obtain satisfactory fusion rate and biomechanical stability of atlantoaxial movement in all directions.