Uehara Masashi, Takahashi Jun, Ogihara Nobuhide, Hirabayashi Hiroki, Mukaiyama Keijiro, Kuraishi Shugo, Shimizu Masayuki, Futatsugi Toshimasa, Hashidate Hiroyuki, Kato Hiroyuki
Department of Orthopaedic Surgery, Yodakubo Hospital, 2857 Furumachi, Nagawamachi, Chiisagatagun, Nagano, 386-0603, Japan.
J Orthop Sci. 2013 Nov;18(6):916-25. doi: 10.1007/s00776-013-0465-3. Epub 2013 Sep 10.
A retrospective single-center study. We routinely have used C1-C2 transarticular and cervical pedicle screw fixations to reconstruct highly destructed unstable rheumatoid arthritis (RA) cervical lesions. However, there is little data on mid-term results of surgical reconstruction for rheumatoid cervical disorders, particularly, cervical pedicle screw fixation.
The purpose of this study was to evaluate the mid-term surgical results of computer-assisted cervical reconstruction for such lesions.
Seventeen subjects (4 men, 13 women; mean age, 61 ± 9 years) with RA cervical lesions who underwent C1-C2 transarticular screw fixation or occipitocervical fixation, with at least 5 years follow-up were studied. A frameless, stereotactic, optoelectronic, CT-based image-guidance system, was used for correct screw placement. Variables including the Japanese Orthopaedic Association (JOA) score, Ranawat class, EuroQol (EQ-5D), atlantodental interval, and Ranawat values before, and at 2 and 5 years after surgery, were evaluated. Furthermore, screw perforation rates were evaluated.
The lesions included atlantoaxial subluxation (AAS, n = 6), AAS + vertical subluxation (VS, n = 7), and AAS + VS + subaxial subluxation (n = 4). There was significant neurological improvement at 2 years after surgery, as evidenced by the JOA scores, Ranawat class, and the EQ-5D utility weight. However, at 5 years after surgery, there was a deterioration of this improvement. The Ranawat values before, and at 2 and 5 years after surgery, were not significantly different. Major screw perforation rate was 2.1 %. No neural and vascular complications associated with screw insertion were observed.
Subjects with rheumatoid cervical lesions who underwent C1-C2 transarticular screw fixation or occipitocervical fixation using a pedicle screw had significantly improved clinical parameters at 2 years after surgery. However, there was a deterioration of this improvement at 5 years post surgery.
一项回顾性单中心研究。我们常规使用C1-C2经关节螺钉固定和颈椎椎弓根螺钉固定来重建高度破坏的不稳定类风湿性关节炎（RA）颈椎病变。然而，关于类风湿性颈椎疾病手术重建的中期结果的数据很少，尤其是颈椎椎弓根螺钉固定。
本研究的目的是评估计算机辅助颈椎重建治疗此类病变的中期手术效果。
对17例接受C1-C2经关节螺钉固定或枕颈固定且至少随访5年的RA颈椎病变患者（4例男性，13例女性；平均年龄61±9岁）进行研究。使用基于CT的无框架、立体定向、光电图像引导系统进行螺钉的正确置入。评估术前、术后2年和5年的变量，包括日本骨科协会（JOA）评分、Ranawat分级、欧洲五维健康量表（EQ-5D）、寰齿间距和Ranawat值。此外，评估螺钉穿孔率。
病变包括寰枢椎半脱位（AAS，n =
6）、AAS + 垂直半脱位（VS，n = 7）和AAS + VS + 下颈椎半脱位（n = 4）。术后2年神经功能有显著改善，JOA评分、Ranawat分级和EQ-5D效用权重证明了这一点。然而，术后5年，这种改善出现了恶化。术前、术后2年和5年的Ranawat值无显著差异。主要螺钉穿孔率为2.1%。未观察到与螺钉置入相关的神经和血管并发症。
接受C1-C2经关节螺钉固定或使用椎弓根螺钉进行枕颈固定的类风湿性颈椎病变患者在术后2年临床参数有显著改善。然而，术后5年这种改善出现了恶化。
