Jing Linkai, Sun Zhenxing, Zhang Peihai, Wang James, Wang Guihuai
School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Beijing, China.
School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Beijing, China.
World Neurosurg. 2018 Sep;117:e653-e659. doi: 10.1016/j.wneu.2018.06.108. Epub 2018 Jun 23.
This study aimed to evaluate the accuracy of screw placement and clinical outcomes in patients undergoing occipitocervical fusion.
Patients who underwent occipitocervical fusion with O-arm-based navigation were retrospectively reviewed between January 2015 and December 2017. The patients' characteristics, clinical and radiographic outcomes, and surgical complications were recorded and analyzed. Cervical screw insertion accuracy was evaluated using the Richter scale.
Thirty consecutive patients (11 male and 19 female) with an average treatment age of 40.03 ± 15.19 years were studied. The most common cause was atlantoaxial instability combined with Chiari malformation (63.33%). Weakness (76.67%) and paresthesia (70.00%) were the most common symptoms. Eighty-six occipital and 139 cervical screws were placed using an O-arm-assisted navigation system. In total, 130 (93.53%) cervical screws were graded as group A and 9 (6.47%) as group B. The optimal accuracy rate was 88.41% (61 of 69 screws) in the first 15 patients and 98.57% (69 of 70 screws) in the subsequent 15 patients. The mean follow-up time was 7.50 ± 5.70 months. The mean Japanese Orthopedic Association scores were 13.30 ± 2.41 preoperatively and 15.30 ± 1.60 at final follow-up (P < 0.001), and the mean recovery rate in the Japanese Orthopedic Association score was 53.26 ± 33.82%. Clinical improvement was seen in 25 patients (83.33%), whereas no change was observed in 5 patients (16.67%). The overall complication rate was 6.67% (2/30), with 1 intraoperative vertebral artery injury and 1 postoperative screw loosening.
Occipitocervical fusion with O-arm-based navigation is effective and safe for treating instability of the craniovertebral junction. Intraoperative navigation can help surgeons insert screws accurately.
本研究旨在评估枕颈融合术患者螺钉置入的准确性及临床疗效。
回顾性分析2015年1月至2017年12月期间接受基于O型臂导航的枕颈融合术的患者。记录并分析患者的特征、临床和影像学结果以及手术并发症。采用里氏量表评估颈椎螺钉置入的准确性。
共研究了30例连续患者（男11例，女19例），平均治疗年龄为40.03±15.19岁。最常见的病因是寰枢椎不稳合并Chiari畸形（63.33%）。最常见的症状是无力（76.67%）和感觉异常（70.00%）。使用O型臂辅助导航系统置入了86枚枕骨螺钉和139枚颈椎螺钉。总共，130枚（93.53%）颈椎螺钉被评为A组，9枚（6.47%）被评为B组。前15例患者的最佳准确率为88.41%（69枚螺钉中的61枚），后15例患者为98.57%（70枚螺钉中的69枚）。平均随访时间为7.50±5.70个月。日本骨科协会平均评分术前为13.30±2.41，末次随访时为15.30±1.60（P<0.001），日本骨科协会评分的平均恢复率为53.26±33.8²%。25例患者（83.33%）临床症状改善，5例患者（16.67%）无变化。总体并发症发生率为6.67%（2/30），包括1例术中椎动脉损伤和1例术后螺钉松动。
基于O型臂导航的枕颈融合术治疗颅颈交界区不稳有效且安全。术中导航可帮助外科医生准确置入螺钉。
