Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland.
Clin Orthop Relat Res. 2011 Mar;469(3):702-7. doi: 10.1007/s11999-010-1548-5.
Fusion is used to address several types of abnormality of the atlantoaxial segment. Traditionally, outcome has been assessed by achieving solid bony union. Recently, however, patient-rated outcome instruments have been increasingly used, although these may be influenced by concomitant comorbidity.
QUESTIONS/PURPOSES: We therefore asked whether patients with rheumatoid arthritis (RA), with its associated comorbidity, had worse self-rated outcomes after C1-2 fusion than patients with osteoarthritis (OA).
We retrospectively reviewed all 30 (23 OA and seven RA) prospectively followed patients in our local Spine Registry (part of the Spine Society of Europe Spine Tango Registry) who had undergone C1-2 fusion. Before surgery and 3 and 12 months later, patients completed the multidimensional Core Outcome Measures Index (COMI) questionnaire. Global outcome and satisfaction with treatment were also assessed.
We found no group differences for duration of operation, blood loss, or perioperative surgical or general complications. Compared with the OA group, the RA group showed a better baseline COMI score and less improvement in the COMI from preoperatively to 12 months followup. However, the proportion of "good" global scores at 12 months followup was similarly high in both groups (87% OA and 86% RA) as was satisfaction (96% for OA versus 86% for RA).
Symptoms and impairment were less severe in the RA group at baseline and showed less improvement after surgery, but the proportion of "good global outcomes" was similar in both groups, and the great majority of patients in both groups were satisfied with their treatment.
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
融合术被用于治疗寰枢段的多种异常。传统上，通过实现坚固的骨性融合来评估结果。然而，最近越来越多地使用了患者自评的结果评估工具，尽管这些工具可能会受到伴随合并症的影响。
问题/目的：因此，我们想知道患有类风湿关节炎（RA）的患者（具有相关合并症）在接受 C1-2 融合后，其自我评估的结果是否比骨关节炎（OA）患者更差。
我们回顾性地分析了我们当地脊柱登记处（欧洲脊柱学会脊柱探戈登记处的一部分）中所有 30 例（23 例 OA 和 7 例 RA）前瞻性随访的患者，这些患者接受了 C1-2 融合术。在手术前以及术后 3 个月和 12 个月，患者完成多维核心结果测量指标（COMI）问卷。还评估了总体结果和对治疗的满意度。
我们发现手术时间、失血量或围手术期手术或一般并发症在两组之间没有差异。与 OA 组相比，RA 组在基线时的 COMI 评分更好，从术前到 12 个月随访时 COMI 的改善更小。然而，两组在 12 个月随访时“良好”总体评分的比例相似（OA 组为 87%，RA 组为 86%），满意度也相似（OA 组为 96%，RA 组为 86%）。
RA 组在基线时的症状和功能障碍较轻，手术后改善较小，但两组的“良好总体结果”比例相似，两组中的大多数患者对治疗都满意。
III 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
