Yuan Bo, Zhou Shengyuan, Chen Xiongsheng, Wang Zhiwei, Liu Weicong, Jia Lianshun
Department of Orthopedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China.
J Orthop Surg Res. 2017 Jul 11;12(1):105. doi: 10.1186/s13018-017-0607-y.
The objectives of this study are to investigate the clinical curative effect of Gallie technique and atlantoaxial screw-rod constructs (SRC) on atlantoaxial sagittal instability and determine the indication of Gallie technique.
Data of 49 patients with atlantoaxial sagittal instability from February 2008 to May 2015 were analyzed retrospectively. The visual analog scale (VAS) score and the neck disability index (NDI) were used to evaluate the curative effect. Postoperative radiological outcomes were used to evaluate the stability of atlantoaxial joint and bone fusion. Perioperative parameters such as blood loss, operation time, radiographic exposure times, and hospital expense were also recorded and analyzed.
Forty-nine patients (36 men and 13 women) were included in this study. The mean age was 41.4 ± 8.9 (range from 19 to 64). All patients were followed up for 24-67 months. Among these patients, 25 of these patients underwent Gallie surgery and 24 underwent SRC surgery. The pain in the occipitocervical area of all the patients has been relieved. NDI scores and VAS scores were lower in Gallie group than in SRC group in early postoperative period. The proportion of the patients who achieved good bone fusion within 3 months after operation was 88.0% (22/25) in the Gallie group and 100% (24/24) in the SRC group. The Gallie group is lower than the SRC group in blood loss, operation time, radiographic exposure times, and hospital expense. Statistical difference was observed between the two groups.
For patients with atlantoaxial instability who has (1) the atlantodental interval (ADI) which is bigger than 5 mm on lateral flexion-extension X-ray, or Anderson-D'Alonzo type II odontoid fracture, (2) no asymmetry between odontoid process and lateral mass on open-mouth anterior-posterior X-ray, and (3) no dislocation of lateral mass joint on the CT 3D reconstruction, Gallie technique can be chosen as a safe and effective method if atlantoaxial reduction can be achieved preoperatively. Compared with SRC, Gallie technique can relieve the pain in the occipitocervical area earlier and it can shorten operation time and reduce intraoperative bleeding, radiographic exposure times, and hospital expense effectively. However, for patients with irreducible atlantoaxial dislocation, the Gallie technique should be used with caution.
本研究旨在探讨Gallie技术和寰枢椎螺钉-棒系统（SRC）治疗寰枢椎矢状面不稳的临床疗效，并确定Gallie技术的适应证。
回顾性分析2008年2月至2015年5月收治的49例寰枢椎矢状面不稳患者的资料。采用视觉模拟评分法（VAS）和颈部功能障碍指数（NDI）评估疗效。术后影像学结果用于评估寰枢椎关节稳定性和骨融合情况。记录并分析围手术期参数，如失血量、手术时间、X线曝光次数和住院费用。
本研究共纳入49例患者（男36例，女13例）。平均年龄为41.4±8.9岁（19～64岁）。所有患者均随访24～67个月。其中，25例行Gallie手术，24例行SRC手术。所有患者枕颈部疼痛均缓解。术后早期Gallie组NDI评分和VAS评分低于SRC组。Gallie组术后3个月内获得良好骨融合的患者比例为88.0%（22/25），SRC组为100%（24/24）。Gallie组在失血量、手术时间、X线曝光次数和住院费用方面均低于SRC组。两组间差异有统计学意义。
对于寰枢椎不稳患者，若（1）颈椎屈伸侧位X线片上寰齿间距（ADI）大于5 mm，或Anderson-D’AlonzoⅡ型齿状突骨折；（2）张口位X线片上齿状突与侧块无不对称；（3）CT三维重建显示侧块关节无脱位，且术前能实现寰枢椎复位，则可选择Gallie技术作为一种安全有效的方法。与SRC相比，Gallie技术能更早缓解枕颈部疼痛，有效缩短手术时间，减少术中出血、X线曝光次数和住院费用。然而，对于寰枢椎脱位无法复位的患者，则应慎用Gallie技术。
