Abumi K, Takada T, Shono Y, Kaneda K, Fujiya M
Department of Orthopaedic Surgery, Hokkaido University, School of Medicine, Sapporo, Japan.
Spine (Phila Pa 1976). 1999 Jul 15;24(14):1425-34. doi: 10.1097/00007632-199907150-00007.
This retrospective study was conducted to analyze the clinical results in 26 patients with lesions at the craniocervical junction that had been treated by occipitocervical reconstruction using pedicle screws in the cervical spine and occipitocervical rod systems.
To evaluate the effectiveness of pedicle screw fixation in occipitocervical reconstructive surgery and to introduce surgical techniques.
Many methods of occipitocervical reconstruction have been reported, but there have been no reports of occipitocervical reconstruction using pedicle screws and occipitocervical rod systems for reduction and fixation.
Twenty-six patients with lesions at the craniocervical junction underwent reconstructive surgery using pedicle screws in the cervical spine and occipitocervical rod systems. The occipitocervical lesions were atlantoaxial subluxation associated with basilar invagination, which was caused by rheumatoid arthritis in 19 patients and other disorders in 7. The lowest cervical vertebra of fusion in 16 patients was C2, and the remaining 10 patients underwent fusion downward from C3 to C7. Flexion deformity of the occipitoatlantoaxial complex was corrected by application of extensional force, and upward migration of the odontoid process was reduced by application of combined force of extension and distraction between the occiput and the cervical pedicle screws.
Solid fusion was achieved in all patients except two with metastatic vertebral tumors who did not receive bone graft for fusion. Correction of malalignment at the craniocervical junction was adequate, and postoperative magnetic resonance imaging showed improvement of anterior compression of the medulla oblongata. There were no neurovascular complications of cervical pedicle screws.
Occipitocervical reconstruction by the combination of cervical pedicle screws and occipitocervical rod systems provided the high fusion rate and sufficient correction of malalignment in the occipitoatlantoaxial region. Results of this study showed the effectiveness of cervical pedicle screw as a fixation anchor for occipitocervical reconstruction.
本回顾性研究旨在分析26例颅颈交界区病变患者采用颈椎椎弓根螺钉及枕颈棒系统进行枕颈重建后的临床结果。
评估椎弓根螺钉固定在枕颈重建手术中的有效性并介绍手术技术。
已有许多枕颈重建方法的报道，但尚无使用椎弓根螺钉及枕颈棒系统进行复位和固定的枕颈重建的报道。
26例颅颈交界区病变患者采用颈椎椎弓根螺钉及枕颈棒系统进行重建手术。枕颈病变为寰枢椎半脱位合并基底凹陷，其中19例由类风湿关节炎引起，7例由其他疾病引起。16例患者融合的最低颈椎为C2，其余10例患者从C3至C7向下融合。通过施加伸展力矫正枕寰枢复合体的屈曲畸形，通过枕骨与颈椎椎弓根螺钉之间的伸展和牵引合力减少齿突向上移位。
除2例转移性椎体肿瘤患者未接受植骨融合外，所有患者均实现了牢固融合。颅颈交界区的畸形矫正充分，术后磁共振成像显示延髓前方压迫改善。颈椎椎弓根螺钉无神经血管并发症。
颈椎椎弓根螺钉与枕颈棒系统联合进行枕颈重建可提供高融合率，并能充分矫正枕寰枢区域的畸形。本研究结果显示颈椎椎弓根螺钉作为枕颈重建的固定锚有效。
