Yang Jun-Song, Chen Hao, Chu Lei, Liu Peng, Yan Liang, Liu Tuan-Jiang, Tian Fang, Zhang Jia-Nan, Hao Ding-Jun
Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Graduate School of Xi'an Medical University, Xi'an, China.
World Neurosurg. 2019 May;125:e29-e34. doi: 10.1016/j.wneu.2018.12.153. Epub 2019 Jan 31.
We sought to explore whether additional bone grafting of the atlantoaxial joint increases the bone fusion rate of iliac crest autograft in posterior occipitocervical fusion surgery.
From January 2012 to January 2016, a total of 78 patients who had basilar invagination with occipitalization of the atlas came to our tertiary spine center. Except for those lost to follow-up (10 cases) or who had a follow-up time <2 years (20 cases), there were 48 patients retrospectively included in this study. In the control group, a piece of autogenous iliac corticocancellous bone was placed between the occipital and C2 vertebral lamina for fusion. In the hybrid fusion group, besides posterior occipitocervical autograft, some granular bone harvested from the iliac crest was packed into the bilateral atlantoaxial joint. X-ray imaging and cervical computed tomography (CT) were performed during follow-up.
The operations were completed successfully in all patients without intraoperative complications. Only 21 (87.5%) patients in the control group had confirmed posterior bony fusion on CT, while 24 (100%) patients in the hybrid fusion group had confirmed posterior bony fusion. There were postoperative implant-related complications in 2 patients. Both cases belonged to the control group (8.3%). Three patients (12.5%) complained of transient numbness in the posterior occipital region: 2 patients in the hybrid group and 1 patient in the control group. The mean duration to posterior occipitocervical fusion was 5.5 months in the hybrid fusion group versus 6.1 months in the control group (P = 0.757). Of note, in the hybrid fusion group, the process of atlantoaxial joint fusion was faster than that of posterior occipitocervical fusion (5.1 months vs. 5.5 months, P = 0.823).
Additional bone grafting of the atlantoaxial joint could increase the bone fusion rate of iliac crest autograft in posterior occipitocervical fusion.
我们试图探讨在枕颈后路融合手术中，额外对寰枢关节进行植骨是否能提高自体髂骨移植的骨融合率。
2012年1月至2016年1月，共有78例合并寰椎枕化的基底凹陷患者来到我们的三级脊柱中心。除失访患者（10例）或随访时间<2年的患者（20例）外，本研究回顾性纳入48例患者。对照组在枕骨与C2椎板之间植入一块自体髂骨皮质松质骨进行融合。在混合融合组中，除了枕颈后路自体骨移植外，还将从髂嵴采集的一些颗粒状骨填充到双侧寰枢关节。随访期间进行X线成像和颈椎计算机断层扫描（CT）。
所有患者手术均成功完成，无术中并发症。对照组仅21例（87.5%）患者CT证实后路骨融合，而混合融合组24例（100%）患者CT证实后路骨融合。有2例患者出现术后植入物相关并发症。两例均属于对照组（8.3%）。3例患者（12.5%）主诉枕后部短暂麻木：混合组2例，对照组1例。混合融合组枕颈后路融合的平均时间为5.5个月，而对照组为6.1个月（P = 0.757）。值得注意的是，在混合融合组中，寰枢关节融合过程比枕颈后路融合更快（5.1个月对5.5个月，P = 0.823）。
额外对寰枢关节进行植骨可提高枕颈后路融合中自体髂骨移植的骨融合率。
