Wolan-Nieroda Andżelina, Maciejczak Andrzej, Guzik Agnieszka, Przysada Grzegorz, Szeliga Ewa, Drużbicki Mariusz
Medical Faculty, University of Rzeszów, Kopisto 2A Avenue, 35-959, Rzeszow, Poland.
Institute of Physiotherapy, University of Rzeszow, Warszawska 26 a, 35-205, Rzeszów, Poland.
J Orthop Surg Res. 2019 Apr 15;14(1):104. doi: 10.1186/s13018-019-1135-8.
It is believed that direct odontoid screw fixation preserves the physiological cervical range of motion following surgery. However, there are no clinical studies confirming the motion sparing value of this technique. This study aims to (1) to assess active cervical range of motion following types II and III odontoid fracture, successfully treated with anterior odontoid screw fixation, and (2) to examine the relationship between the range of motion of the head and duration of collar usage, neck pain, quality of life, and patients' age.
The study involved 41 patients subjected to a procedure of direct osteosynthesis of the dens with lag screw. Following the operation all the patients had to wear a cervical collar to protect the osteosynthesis. The control group consisted of 41 individuals with no clinical diagnosis of any cervical spine disorders. The spinal motion was assessed using multi-cervical unit, taking into account bending/extension, left and right lateral flexion, and left and right axial rotation.
In the study group, spine mobility correlated with the duration of hard collar usage following the operation, with a longer duration corresponding to poorer spine mobility at the end of the treatment. Statistically significant correlation was observed in the case of extension (p < 0.021) and axial rotation (p < 0.007). In the study group, there was a negative correlation between the range of motion and the patients' age, i.e., the older the patient the poorer his/her spinal mobility (p < 0.001).
Active cervical range of motion in patients following direct osteosynthesis of the dens, augmented with a hard collar, was significantly lower than in the control population, and it correlated negatively with the duration of collar usage, the patients' age, and intensity of spinal pain.
人们认为齿突螺钉直接固定术可在术后保留颈椎的生理活动范围。然而，尚无临床研究证实该技术的运动保留价值。本研究旨在：（1）评估经前路齿突螺钉固定术成功治疗的Ⅱ型和Ⅲ型齿突骨折患者术后的颈椎主动活动范围；（2）研究头部活动范围与颈托使用时长、颈部疼痛、生活质量及患者年龄之间的关系。
本研究纳入41例行齿突拉力螺钉直接骨合成术的患者。术后所有患者均需佩戴颈托以保护骨合成部位。对照组由41例无任何颈椎疾病临床诊断的个体组成。采用多节段颈椎单元评估脊柱活动度，包括前屈/后伸、左右侧屈以及左右轴向旋转。
在研究组中，脊柱活动度与术后硬颈托使用时长相关，使用时长越长，治疗结束时脊柱活动度越差。在后伸（p < 0.021）和轴向旋转（p < 0.007）方面观察到具有统计学意义的相关性。在研究组中，活动范围与患者年龄呈负相关，即患者年龄越大，脊柱活动度越差（p < 0.001）。
经齿突直接骨合成术并辅以硬颈托治疗的患者，其颈椎主动活动范围显著低于对照组人群，且与颈托使用时长、患者年龄及脊柱疼痛强度呈负相关。
