Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China.
Department of Traditional Chinese Medicine Rehabilitation, Zhabei Central Hospital, Shanghai, People's Republic of China.
Spine (Phila Pa 1976). 2017 Oct 15;42(20):1587-1593. doi: 10.1097/BRS.0000000000002152.
Retrospective comparative study.
To compare the outcomes of C1-C2 transarticular screw with C1 laminar hook (TAS + C1H) fixation and C1 trans-arch lateral mass screw with C2 pedicle screw (C1TLMS + C2PS) fixation in the treatment of reducible atlantoaxial dislocation (AAD).
TAS + C1H is comparable to TAS with posterior wiring techniques and superior to C1 lateral mass screw combined with C2 pedicle screw (C1LMS + C2PS) in biomechanics. There were, however, few studies analyzing the differences in outcomes between TAS + C1H technique and modified C1LMS + C2PS technique (C1TLMS + C2PS) for treating AAD.
Data of 30 patients with reducible AAD treated by TAS + C1H fixation and another 30 cases treated by C1TLMS + C2PS fixation were retrospectively analyzed. Bone fusion time was recorded. The outcomes evaluated by American Spinal Injury Association impairment scale, visual analog scale score for neck pain, neck stiffness (none/mild/severe), patient satisfaction, and Neck Disability Index (NDI) were compared between two groups.
There were no complications related to the surgical approach and instrumentation in either group. At the final follow-up, bone graft fusion rates were 100% in both the TAS + C1H fixation group and the C1TLMS + C2PS fixation group (P > 0.05). The neurological status evaluated by American Spinal Injury Association impairment scale were greatly improved in both screw-hook group (P < 0.001) and screw-rod group (P < 0.001), but with no significant differences between groups (P > 0.05). There were no significant differences between two groups in visual analog scale score for neck pain, neck stiffness, patient satisfaction, or Neck Disability Index (all P > 0.05).
C1TLMS + C2PS fixation was comparable to TAS + C1H fixation in fusion rate and functional outcomes for treating reducible AAD. To reduce the risk of vertebral artery injury, computed tomography scan, and reconstruction should be done to analyze vertebral artery course and C1-C2 anatomic structures before operation.
回顾性对比研究。
比较经 C1-C2 关节突螺钉（TAS+C1H）固定与 C1 侧块经弓根螺钉（C1TLMS+C2PS）固定治疗可复位寰枢椎脱位（AAD）的疗效。
TAS+C1H 在生物力学上与后路钢丝技术相当，优于 C1 侧块螺钉与 C2 椎弓根螺钉（C1LMS+C2PS）联合固定。然而，很少有研究分析 TAS+C1H 技术与改良 C1LMS+C2PS 技术（C1TLMS+C2PS）治疗 AAD 疗效的差异。
回顾性分析 30 例采用 TAS+C1H 固定治疗和 30 例采用 C1TLMS+C2PS 固定治疗的可复位 AAD 患者资料。记录骨融合时间。采用美国脊髓损伤协会损伤评分、颈痛视觉模拟评分、颈部僵硬（无/轻度/重度）、患者满意度和颈椎残障指数（NDI）评估两组疗效。
两组均无与手术入路和内固定相关的并发症。末次随访时，TAS+C1H 固定组和 C1TLMS+C2PS 固定组植骨融合率均为 100%（P>0.05）。螺钉-钩组（P<0.001）和螺钉-棒组（P<0.001）的神经功能均有明显改善，但两组间差异无统计学意义（P>0.05）。两组患者颈痛视觉模拟评分、颈部僵硬、患者满意度和颈椎残障指数差异均无统计学意义（均 P>0.05）。
在可复位 AAD 的治疗中，C1TLMS+C2PS 固定与 TAS+C1H 固定在融合率和功能结果方面具有可比性。为降低椎动脉损伤风险，术前应行 CT 扫描和重建，分析椎动脉走行和 C1-C2 解剖结构。
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