Li Guangzhou, Liu Hao, Ding Chen, Yang Yi, Meng Yang, Duan Yuchen, Chen Hua, Hong Ying
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China.
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Jan 15;33(1):35-40. doi: 10.7507/1002-1892.201807115.
To assess the application and the effectiveness of a strategy of combining posterior occipitocervical angle (POCA) with occipital-C (O-C ) angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion.
The clinical data of 22 patients undergoing posterior instrumented occipitocervical fusions between March 2013 and January 2016 were retrospectively analysed, and all patients were performed by using a strategy combining with POCA and O-C angle for adjustment of occipitocervical fixation angle. All patients suffered from occipitocervical instability, including 7 males and 15 females with an average age of 44.4 years (range, 20-63 years). The patients were diagnosed as skull base depression with atlantoaxial dislocation in 20 cases and rheumatoid arthritis in 2 cases. The preoperative Japanese Orthopaedic Association (JOA) score was 13.2±2.0, and the visual analogue scale (VAS) score was 6.3±0.9. The POCA was first used to guide the pre-bending of the nail-rod system during the operation, so that POCA of 12 patients with abnormal preoperative POCA could be restored to the normal range; then intraoperative fluoroscopy was used to confirm whether the O-C angle was within the normal range (4 cases were abnormal and 2 cases needed intraoperative adjustment); finally, POCA and O-C angles were within normal range after adjustment. The postoperative complications were recorded, and the JOA and VAS scores were used to evaluate the recovery of spinal nerve function and the degree of pain relief after operation. The radiological data were collected to evaluate the bone graft fusion, the changes of postoperative POCA, O-C angle, and lower cervical curvature (Cobb angle).
All 22 patients were followed up 12-48 months, with an average of 24 months. No serious complications and reoperation occurred. At last follow-up, the VAS score and JOA score were 2.9±0.8 and 15.4±0.9 respectively, which were significantly improved when compared with preoperative ones ( =15.870, =0.000; =6.587, =0.000). Imaging examination showed that 22 patients had occipitocervical osseous fusion, good position of internal fixator without loosening or fracture, and good occipitocervical stability. The POCA and O-C angles were within the normal range at 3 days after operation and at last follow-up, and there were significant differences when compared with preoperative ones ( <0.05); but no significant difference was found in POCA and O-C angles between at 3 days after operation and at last follow-up ( >0.05). There was no significant difference in Cobb angle of lower cervical spine between before and after operation ( >0.05).
The strategy of combination POCA and O-C angle for adjustment of occipitocervical fixation angle during operation can ensure a better effectiveness.
评估在后路枕颈融合内固定术中联合应用后枕颈角（POCA）与枕颈角（O-C角）来调整枕颈固定角度的应用情况及有效性。
回顾性分析2013年3月至2016年1月行后路枕颈融合内固定术的22例患者的临床资料，所有患者均采用联合POCA与O-C角的策略来调整枕颈固定角度。所有患者均存在枕颈不稳，其中男性7例，女性15例，平均年龄44.4岁（范围20 - 63岁）。患者诊断为颅底凹陷合并寰枢椎脱位20例，类风湿关节炎2例。术前日本骨科协会（JOA）评分为13.2±2.0，视觉模拟量表（VAS）评分为6.3±0.9。术中首先使用POCA指导钉棒系统预弯，使12例术前POCA异常的患者恢复至正常范围；然后术中透视确认O-C角是否在正常范围内（4例异常，2例需术中调整）；最终调整后POCA和O-C角均在正常范围内。记录术后并发症，采用JOA和VAS评分评估术后脊髓神经功能恢复及疼痛缓解程度。收集影像学资料评估植骨融合情况、术后POCA、O-C角及下颈椎曲度（Cobb角）的变化。
22例患者均获随访12 - 48个月，平均24个月。未发生严重并发症及再次手术。末次随访时，VAS评分和JOA评分分别为2.9±0.8和15.4±0.9，与术前相比均显著改善（ =15.870， =0.000； =6.587， =0.000）。影像学检查显示22例患者均获枕颈骨性融合，内固定位置良好，无松动或断裂，枕颈稳定性良好。术后3天及末次随访时POCA和O-C角均在正常范围内，与术前相比差异有统计学意义（ <0.05）；但术后3天与末次随访时POCA和O-C角比较差异无统计学意义（ >0.05）。手术前后下颈椎Cobb角比较差异无统计学意义（ >0.05）。
术中联合POCA与O-C角调整枕颈固定角度的策略可确保更好的疗效。
