Posterior screw-rod fixation fusion for the treatment of atlantoaxial dislocation due to rheumatoid arthritis

Ma Xiang-yang; Zou Xiaobao; Yang Jincheng; Wang Binbin; Yang Haozhi; Xia Hong; Wu Zenghui; Yin Qingshui

doi:10.3760/cma.j.issn.0253-2352.2017.24.001

点赞 0
分享 0
收藏 0
纠错

• 颈椎疾患 •

后路寰枢椎钉-棒系统固定融合术治疗类风湿性寰枢椎脱位

中华骨科杂志, 2017,37(24) : 1505-1510. DOI: 10.3760/cma.j.issn.0253-2352.2017.24.001

摘要

目的

探讨后路寰枢椎钉-棒系统固定融合术治疗类风湿性寰枢椎脱位的临床疗效。

方法

2011年1月至2015年12月，收治15例类风湿性寰枢椎脱位患者，男6例，女9例；年龄35~75岁，平均55岁。术前摄动力位X线片评估寰枢椎脱位的复位难易程度。均于气管插管全身麻醉下施行后路寰枢椎钉-棒系统提拉复位、固定、自体髂骨植骨融合术治疗。测量手术前后寰齿间隙（atlantodental interval，ADI）；采用疼痛视觉模拟评分（visual analogue scale，VAS）评估颈项部疼痛程度，采用美国脊柱损伤协会（American spinal injury association，ASIA）运动评分评估运动功能，采用ASIA脊髓损伤分级及日本骨科协会（Japanese Orthopaedic Association Scores，JOA）评分评估神经功能。术后1周、3、6、12个月及之后每年随访时均行X线、CT检查，以评价寰枢椎椎间复位稳定性、内固定及植骨融合情况。

结果

15例患者均为可复性寰枢椎脱位，均成功实施后路寰枢椎钉-棒系统固定融合术。15例患者均获得随访，随访时间3~24个月，平均15个月。术后3~6个月均获得骨性融合。ADI自术前（6.3±1.7）mm降至术后（2.2±0.8）mm，VAS评分由术前（5.4±2.7）分降至术后（1.7±1.0）分，ASIA运动评分由术前（82.3±15.6）分提高至术后6个月时（95.3±4.5）分，JOA评分由术前（13.8±2.9）分提高至术后6个月时（15.5±1.4）分，手术前后差异均有统计学意义。术前9例ASIA分级D级患者中3例术后改善为E级，2例术后6个月改善为E级，2例术后12个月改善至E级，余2例术后无变化。随访期间X线片、CT复查显示寰枢椎内固定无松动，无复发脱位。

结论

类风湿性寰枢椎脱位大多为可复性脱位，后路寰枢椎钉-棒系统固定融合术可实现良好复位和可靠固定，自体髂骨植骨融合可获得满意的骨性融合，临床疗效满意。

引用本文: 马向阳, 邹小宝, 杨进城, 等. 后路寰枢椎钉-棒系统固定融合术治疗类风湿性寰枢椎脱位 [J] . 中华骨科杂志,2017,37 (24): 1505-1510. DOI: 10.3760/cma.j.issn.0253-2352.2017.24.001

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

扫描看全文

正文

作者信息

基金 0 关键词 0

English Abstract

阅读 0 评论 0

相关资源

引用 | 论文 | 视频

版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

临床上多种原因可导致寰枢椎脱位，如先天性畸形、创伤、炎症及肿瘤等。类风湿性关节炎是一种慢性全身性疾病，发展到一定程度常累及颈椎，导致颈椎稳定性下降，引起各种颈椎不稳，颈椎受累节段中以上颈椎最为多见，发生率可达43.6%~86%^[1]。寰枢椎关节受累最早可表现为寰枢椎半脱位^[2]，而引起寰枢椎脱位的主要病理改变为齿突周围形成的类风湿血管翳的侵蚀，造成齿突、横韧带、翼状韧带等韧带复合体、关节囊、关节软骨、滑膜以及寰枢侧块关节等结构破坏^[1]。

贡献者信息

马向阳

510010　广州，解放军广州总医院骨科医院脊柱外科

邹小宝

510010　广州，解放军广州总医院骨科医院脊柱外科

杨进城

510010　广州，解放军广州总医院骨科医院脊柱外科

王宾宾

510010　广州，解放军广州总医院骨科医院脊柱外科

杨浩志

510010　广州，解放军广州总医院骨科医院脊柱外科

夏虹

510010　广州，解放军广州总医院骨科医院脊柱外科

吴增晖

510010　广州，解放军广州总医院骨科医院脊柱外科

尹庆水

510010　广州，解放军广州总医院骨科医院脊柱外科

关键词

颈寰椎; 枢椎; 脱位; 关节炎，类风湿; 脊柱融合术;

基金项目

广东省省级科技计划项目（2015B020233013）

作者声明

【证据等级】治疗性研究Ⅳ级

历史

出版日期：2017-12-16

收稿日期：2017-07-18

本文编辑

万瑜

Disease of Cervical Vertebrae

Posterior screw-rod fixation fusion for the treatment of atlantoaxial dislocation due to rheumatoid arthritis

Ma Xiang-yang, Zou Xiaobao, Yang Jincheng, Wang Binbin, Yang Haozhi, Xia Hong, Wu Zenghui, Yin Qingshui

Published 2017-12-16

Cite as Chin J Orthop, 2017,37(24): 1505-1510. DOI: 10.3760/cma.j.issn.0253-2352.2017.24.001

Abstract

Objective

To investigate the clinical effect of posterior screw-rod fixation fusion for the treatment of atlantoaxial dislocation due to rheumatoid arthritis.

Methods

From January 2011 to December 2015, 15 patients with atlantoaxial dislocation due to rheumatoid arthritis were treated, including 6 males and 9 females, aged 35 to 75 years (mean 55 years). All cases were evaluated about the difficulty of relocation by extension-flexion X-ray and treated with posterior screw-rod reduction, fixation and autogenous bone grafting under general anesthesia. Atlantodental interval (ADI) was measured and collected before and after surgery. Visual Analogue Scale/Score (VAS), American Spinal Cord Injury Association (ASIA) and Japanese Orthopaedic Association (JOA) scores were comprehensively used to evaluate the clinical effect. 1 week, 3, 6, 12 months postoperatively and the annual review of the X-ray and CT were checked, in order to evaluate the reduction, internal fixation and bone graft fusion.

Results

All patients were reducible dislocation and successfully performed the posterior screw-rod fixation fusion surgery. The patients were followed up for 3 to 24 months (average, 15 months). Atlantoaxial solid bony fusion was obtained from 3 to 6 months. ADI reduced from preoperative 6.3±1.7 mm to postoperative 2.2±0.8 mm, VAS score reduced from preoperative 5.4±2.7 to postoperative 1.7±1.0, ASIA motor score improved from preoperative 82.3±15.6 to 95.3±4.5 at 6 months after the surgery, JOA score increased from preoperative 13.8±2.9 to 15.5±1.4 at 6 months after the surgery, and the statistical significance was revealed between preoperation and postoperation. Nine cases were in D grade of ASIA, 3 cases improved from D to E grade after surgery, 2 cases reached E grade in the other 6 cases after 6 months, 2 cases recovered to E grade after 12 months and other 2 cases in D grade got uniformity after surgery. Well internal fixation and no redislocation were found on X-ray and CT during follow-up period.

Conclusion

Atlantoaxial dislocation because of rheumatoid arthritis was numerously reducible genre. Posterior screwrod fixation and autogenous bone grafting can gain satisfying clinical efficacy.

Key words:

Cervical atlas; Axis; Dislocations; Arthritis, Rheumatoid; Spinal fusion

Contributor Information

Ma Xiang-yang