寰枢椎脱位不同后路融合术对相邻节段退变的影响

发布时间：2018-01-18 10:19

本文关键词：寰枢椎脱位不同后路融合术对相邻节段退变的影响　出处：《中国脊柱脊髓杂志》2017年01期 　论文类型：期刊论文

【摘要】：目的:观察寰枢椎脱位不同后路融合术对其相邻节段退变的影响。方法:2000年6月~2010年6月共纳入43例寰枢椎脱位患者,按照后路融合方式分为寰枢融合组(23例)和枕颈融合组(20例)。记录两组患者末次随访时相邻节段C2-3半脱位(SAS)的出现率及活动度,术前及末次随访时的C2/3椎间隙高度与C3椎体高度的比值(S值)及C2-7矢状位角度,并进行统计学比较。结果:两组术前的JOA评分、S值及C2-7矢状位角度差异均无统计学意义(P0.05)。寰枢融合组随访时间为7.40±1.51年,枕颈融合组随访时间为6.97±1.32年,组间比较无统计学差异(P0.05)。23例行寰枢融合术者出现2例SAS(8.7%),20例行枕颈融合术者出现7例SAS(35%),差异有统计学意义(P0.05)。寰枢融合组和枕颈融合组末次随访时S值均较术前减小,枕颈融合组S值减小更明显,两组之间差异有统计学意义(P0.05)。末次随访时,寰枢融合组及枕颈融合组C2-3活动度分别为3.78°±3.01°和1.45°±1.72°,两组比较有统计学差异(P0.05)。寰枢融合组C2-7矢状位角度由术前的15.16°±5.66°降至末次随访的12.40°±9.34°,枕颈融合组由术前的15.54°±6.54°降至末次随访的-0.22°±12.45°,两组末次随访的C2-7矢状位角度有统计学差异(P0.05)。结论:寰枢融合术比枕颈融合术的颈椎相邻节段退变发生率低、程度轻,临床上应严格掌握手术指征,不要轻易行枕颈融合。
[Abstract]:Objective: to observe the effect of different posterior fusion of atlantoaxial dislocation on adjacent segmental degeneration. Methods: from June 2000 to June 2010, 43 patients with atlantoaxial dislocation were included. According to the posterior approach, the patients were divided into atlantoaxial fusion group (n = 23) and occipitocervical fusion group (n = 20). The ratio of C _ 2 / 3 intervertebral space height to C _ 3 vertebral body height and the sagittal angle of C _ 2-7 were compared before and after the last follow-up. Results: the preoperative JOA scores of the two groups were compared. There was no significant difference in S value and C2-7 sagittal angle (P 0.05). The follow-up time of atlantoaxial fusion group was 7.40 卤1.51 years. The follow-up time of occipitocervical fusion group was 6.97 卤1.32 years. There was no significant difference between the two groups. In 20 cases of occipitocervical fusion, 7 cases had SASV 35, the difference was statistically significant (P 0.05). The S values of atlantoaxial fusion group and occipitocervical fusion group at the last follow-up were lower than those before operation. The S value of occipitocervical fusion group decreased more obviously, and the difference between the two groups was statistically significant (P 0.05). C2-3 activity of atlantoaxial fusion group and occipitocervical fusion group were 3.78 掳卤3.01 掳and 1.45 掳卤1.72 掳, respectively. The sagittal angle of C2-7 in atlantoaxial fusion group decreased from 15.16 掳卤5.66 掳before operation to 12.40 掳卤9.34 掳at the last follow-up. The occipitocervical fusion group decreased from 15.54 掳卤6.54 掳before operation to -0.22 掳卤12.45 掳at the last follow-up. The C2-7 sagittal angle was significantly different between the two groups. Conclusion: atlantoaxial fusion has lower incidence and less degree of cervical degeneration than occipitocervical fusion. Clinically, we should strictly grasp the surgical indications and do not easily perform occipitocervical fusion.
【作者单位】：中日友好医院脊柱外科;
【基金】：首都临床特色重大研究项目(编号:Z161100000516009)
【分类号】：R687.3
【正文快照】： 寰枢椎脱位(atlantoaxial dislocation,AAD)常累及延髓生命中枢与椎-基底动脉,可导致严重残疾,甚至威胁生命。常需要通过手术重建其稳定性,恢复并保持其生理功能。治疗寰枢椎脱位的主要后路手术方式包括枕颈融合术与寰枢融合术。随着脊柱外科理论与手术技术的提升,目前枕颈融

【参考文献】