摘要
目的 探讨两种术式对颈椎矢状面平衡的影响,为临床选择治疗齿状突骨折合并上颈椎不稳的手术方式及评价预后提供参考。方法 回顾性分析2015-01—2019-01在郑州大学第一附属医院行手术治疗的48例齿状突骨折合并上颈椎不稳患者的资料,依据术式分为寰枢椎融合术(AAF)组31例和枕颈融合术(OCF)组17例。比较2组患者术前、术后3天及末次随访时的影像学参数:O~C_(2)角、O~EA角、C_(1~2)角、C_(2~7)SVA和C_(2~7)Cobb角;并计算dO~C_(2)角、dO~EA角、dC C_(1~2)角、dSVA和dCobb角。结果 AAF组和OCF组术后C_(2~7)Cobb角均较术前显著减小,O~C_(2)角、O~EA角、C_(2~7)SVA较术前显著增大,OCF组的dSVA和dCobb角的绝对值均显著大于AAF组,差异均有统计学意义(P<0.05)。Pearson相关系数分析显示:OCF组dO~C_(2)角与dCobb角间存在显著相关性(R=0.54,R^(2)=0.29,P<0.05),dO~C_(2)角与dO~EA角间也存在显著相关性(R=0.55,R^(2)=0.30,P<0.05)。结论 后入路AAF术和OCF术均会导致下颈椎的退变。与AAF术比较,OCF术后患者下颈椎矢状面平衡退变更为严重。行OCF术时,建议术中监测枕颈角(O~C_(2)角)的固定角度,角度增加过多可能会加速下颈椎的退变。
Objective To explore the effects of two surgical methods on cervical sagittal plane balance,and to provide reference for clinical selection of surgical methods for odontoid fracture complicated with upper cervical instability and prognosis evaluation.Methods The data of 48 patients with odontoid fracture complicated with upper cervical instability who underwent surgical treatment in the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2019 were retrospectively analyzed.There were 31 cases atlantoaxial fusion(AAF)group and 17 cases occipitocervical fusion(OCF)group.The imaging parameters of the two groups were compared before surgery,3 days after surgery and at the last follow-up:O~C_(2) Angle,O~EA Angle,C 1~C_(2) Angle,C_(2~7) SVA and C_(2~7) Cobb Angle.The dO~C_(2) Angle,dO~EA Angle,dC_(1~2) Angle,dSVA and dCobb Angle are calculated.Results Postoperative C_(2~7) Cobb angle were significantly decreased in both AAF and OCF groups,while the O~C_(2) angle,O~EA angle and C_(2~7) SVA were significantly increased in both groups.The absolute values of dSVA and dCobb angle in OCF group were significantly greater than those in AAF group.The differences were statistically significant(P<0.05).Pearson correlation coefficient analysis showed that there was a significant correlation between dO~C_(2) angle and dCobb angle in OCF group(R=0.54,R^(2)=0.29,P<0.05),and there was also a significant correlation between dO~C_(2) angle and dO~EA angle(R=0.55,R^(2)=0.30,P<0.05).Conclusion Both posterior approach AAF and OCF can result in degeneration of the lower cervical spine.Compared with AAF,posterior sagittal balance of the lower cervical vertebra was significantly reduced after OCF.Intraoperative monitoring of occipitocervical Angle(O~C_(2) Angle)fixation is recommended during OCF.Excessive increase in the Angle may accelerate the degeneration of the lower cervical spine.
作者
周嘉辉
杨科荣
张杨
张博文
段寒
谭洪宇
Zhou Jiahui;Yang Kerong;Zhang Yang;Zhang Bowen;Duan Han;Tan Hongyu(Spinal Surgery Department,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《河南外科学杂志》
2023年第2期11-14,共4页
Henan Journal of Surgery
基金
河南省高等学校重点科研项目(项目编号:22A320066)。
关键词
齿状突骨折
上颈椎不稳
寰枢椎融合术
枕颈融合术
颈椎矢状面平衡
Odontoid fracture
Instability of the upper cervical spine
Atlantoaxial fusion
Occipitocervical fusion
Sagittal balance of the cervical spine
