枢椎椎板螺钉固定与枢椎椎弓根螺钉固定对枕颈融合术临床疗效的影响

目的探讨经枢椎椎弓根螺钉与经枢椎椎板螺钉固定对枕颈融合术临床疗效的影响。方法选取2007年4月—2012年2月在本院行枕颈融合术的患者66例,回顾分析其临床资料、影像学资料以及随访资料。按照术式分为经枢椎椎弓根螺钉枕颈融合组(A组,37例)和经单侧枢椎椎板螺钉枕颈融合组(B组,29例)。对2组患者的颈髓角、日本骨科学会(JOA)评分、Odom功能分级以及寰枢关节复位情况进行分析比较。结果 2组患者术后随访26~56个月,平均37.6个月。术后1周及末次随访JOA评分与术前相比差异有统计学意义(P0.05),各时间点组间差异无统计学意义(P0.05)。2组患者术后1周颈髓角均有较大改善,与术前相比差异有统计学意义(P0.05);末次随访时2组患者颈髓角均有丢失,但与术后1周相比差异无统计学意义(P0.05);各时间点组间差异无统计学意义(P0.05)。术后3 d时A组解剖复位36例(97.3%),B组解剖复位27例(93.2%),差异无统计学意义(P0.05);末次随访时A组解剖复位丢失1例(2.7%),B组解剖复位丢失6例(20.7%),组间差异有统计学意义(P0.05)。末次随访时所有患者均骨性融合,随访过程中未发生严重并发症及后遗症。结论 2种融合方式均可取得满意的临床疗效,且对颈髓的减压充分。经椎弓根螺钉枕颈融合术可获得长期复位效果,是枕颈融合的首选术式。对必须采用经椎板螺钉枕颈融合的患者,术中应充分植骨,以增加复位的强度和稳定性。

Influence of axis vertebral plate screw fixation and axis pedicle screw fixation on clinical outcomes of occipitocervical fusion

Objective To explore the influence of axis pedicle screw fixation and axis laminar screw fixation on the clinical outcomes of occipitocervical fusion. Methods Clinical data of 66 patients undergoing occipitocervical fusion between April 2007 and February 2012 were analyzed retrospectively. According to surgical approach, the patients were divided into 2 groups:axis pedicle screw fixation for occipitocervical fusion(group A, 37 cases) and axis laminar screw fixation(group B, 29 cases). The cervicomedullary angle, Japanese Orthopaedic Association(JOA) score, Odom assessment and reduction of atlantoaxial joint were analyzed and compared. Results All the cases were followed up for 26-56 months. The JOA scores at postoperative 1 week and at the final follow-up were statistically significant different from those of pre-operation(P<0.05). But there was no significant difference between 2 groups at any time point(P>0.05). The difference in cervicomedullary angle between pre-operation and postoperative 1 week was statistically significant(P<0.05). Compared with postoperative 1 week, there was partial loss of cervicomedullary angle in 2 groups at final follow-up, but the difference was not statistically significant(P>0.05). There were 36 patients(97.3%) getting anatomic reduction 3 d after surgery in group A, and 27(93.2%) in group B, and the difference was not statistically significant(P>0.05). At the final follow-up, the anatomic reduction was lost in 1 patient(2.7%) of group A, and in 6 patients(20.7%) of group B, and the difference was statistically significant(P<0.05). Bony fusion was obtained in all the patients at final follow-up. No serious complications and sequelae happened during the follow-up. Conclusion Good clinical efficacy and full decompression of the cervical spinal cord can be achieved by 2 fusion approaches. Pedicle screw fixation can obtain reliable long-term reduction, thus being the first choice for the occipitocervical fusion. For the patients who must be treated with laminar screw fusion, bone grafting should be adequate intraoperatively to enhance the strength and stability of reduction.