Song Jipeng, Yi Ping, Wang Yanlei, Gong Long, Sun Yan, Yang Feng, Tang Xiangsheng, Tan Mingsheng
Graduate School of Peking Union Medical College, Beijing, 100029, People's Republic of China.
Orthopedics Department, China-Japan Friendship Hospital, Beijing, People's Republic of China.
Arch Orthop Trauma Surg. 2022 Apr;142(4):543-551. doi: 10.1007/s00402-020-03641-x. Epub 2020 Oct 30.
Posterior C1-C2 pedicle screw fixation is a reliable technique used in treatment of type II odontoid fracture. However, the loss of cervical range of rotation motion (RORM) was inevitable. There were few studies focusing on the influence of short-term C1-C2 fixation with nonfusion technique to preserve cervical function in patients younger than 60 years. The purpose of this study was to compare cervical RORM which was measured by an improved goniometer, and the clinical outcomes between short-term and long-term C1-C2 fixation techniques in the treatment of Grauer type 2B and 2C odontoid fracture.
This study represents a retrospective analysis, including patients who underwent primary C1-C2 fixation surgery. These patients were divided into short-term and long-term groups based on whether underwent a fixation removal operation. The clinical results were collected and compared between the two groups. Independent T test and Chi-square analyses were used to identify significant differences between the two groups and dependent T test was used within each group. Statistical significance was set at p < .05.
There were no severe postoperative complications, and all 60 patients achieved spinal stabilization after primary surgery. The mean rotation angle in the short-term group at last follow-up time was 138.39 ± 21.06°, which was better than 83.59 ± 13.06° in the long-term group (p < .05). The same statistical difference was observed in flexion-extension angle, which was 71.11 ± 18.73° in short-term group and 53.34 ± 18.23° in long-term group. The mean NDI score in short-term group at last follow-up time was 1.23 ± 0.86 and better than 8.24 ± 3.17 in long-term group. However, the VAS score in short-term group was 1.82 ± 0.54 which was worse compared to 0.64 ± 0.29 in long-term group.
The results demonstrated that primary C1-C2 fixation with nonfusion technique could support satisfactory clinical effects. In addition, the removal of instruments after bony fusion could improve the function of cervical movement significantly in patients under 60 years.
C1-C2 后路椎弓根螺钉固定术是治疗 II 型齿状突骨折的可靠技术。然而，颈椎旋转活动度（RORM）的丧失不可避免。很少有研究关注非融合技术短期 C1-C2 固定对 60 岁以下患者保留颈椎功能的影响。本研究的目的是比较采用改良角度计测量的颈椎 RORM，以及短期和长期 C1-C2 固定技术治疗 Grauer 2B 型和 2C 型齿状突骨折的临床疗效。
本研究为回顾性分析，纳入接受初次 C1-C2 固定手术的患者。根据是否接受内固定取出手术，将这些患者分为短期组和长期组。收集两组的临床结果并进行比较。采用独立样本 t 检验和卡方分析确定两组间的显著差异，每组内采用配对 t 检验。设定统计学显著性水平为 p < 0.05。
术后无严重并发症，60 例患者初次手术后均实现脊柱稳定。短期组末次随访时的平均旋转角度为 138.39°±21.06°，优于长期组的 83.59°±13.06°（p < 0.05）。屈伸角度也观察到相同的统计学差异，短期组为 71.11°±18.73°，长期组为 53.34°±18.23°。短期组末次随访时的平均 NDI 评分为 1.23±0.86，优于长期组的 8.24±3.17。然而，短期组的 VAS 评分为 1.82±0.54，比长期组的 0.64±0.29 更差。
结果表明，采用非融合技术的初次 C1-C2 固定可获得满意的临床效果。此外，60 岁以下患者在骨融合后取出内固定可显著改善颈椎活动功能。
