Kim Gang-Un, Ahn Myun-Whan, Lee Gun Woo
Department of Orthopaedic Surgery, Hanil General Hospital, Seoul, Korea.
Department of Orthopaedic Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, South Korea.
Global Spine J. 2022 Oct;12(8):1715-1722. doi: 10.1177/2192568220987535. Epub 2021 Jan 25.
Retrospective comparative study.
Although some studies have discussed the use of lateral mass screws (LMSs) in patients with cerebral palsy (CP), it is unclear whether posterior LMS fixation alone is a suitable method. We aimed to compare the clinical, radiological, and surgical outcomes of 2 surgical modalities, namely, combined anterior-posterior (A-P) instrumented fusion and posterior fusion alone, in athetoid-type CP patients with cervical myelopathy (CM).
We analyzed 63 patients with athetoid-CP and CM who underwent posterior fusion only with LMS (group A, 35 patients) and A-P fusion (group B, 28 patients). The primary outcome was the 1- and 3-year fusion rates for the surgical segments. The secondary outcomes included the clinical outcomes based on pain intensity determined using the visual analog scale score, neck disability index, and 17-point Japanese Orthopedic Association score, radiological, and surgical outcomes.
Fusion was achieved at 3 years postoperatively in 22 of 35 patients (63%) in group A and in 26 of 28 patients (93%) in group B ( = 0.02). The posterior neck pain intensity was also significantly lower in group B than in group A 2 and 3 years postoperatively ( = 0.02 and 0.01, respectively). The incidence of screw loosening and implant-related problems was higher in group A (60%) than in group B (21%) ( = 0.01). The other clinical and radiological parameters were similar between the groups.
For athetoid CP-induced CM, combined A-P fusion would result in superior clinical and radiological outcomes compared to posterior fusion alone.
回顾性比较研究。
尽管一些研究讨论了在脑瘫（CP）患者中使用侧块螺钉（LMS），但仅后路LMS固定是否为合适的方法尚不清楚。我们旨在比较两种手术方式，即前后联合（A-P）器械融合术和单纯后路融合术，在患有痉挛性截瘫型颈椎病（CM）的手足徐动型CP患者中的临床、影像学和手术效果。
我们分析了63例患有手足徐动型CP和CM的患者，他们分别接受了仅使用LMS的后路融合术（A组，35例患者）和A-P融合术（B组，28例患者）。主要结局是手术节段的1年和3年融合率。次要结局包括基于视觉模拟量表评分、颈部残疾指数和日本骨科协会17分评分确定的疼痛强度的临床结局、影像学结局和手术结局。
A组35例患者中有22例（63%）在术后3年实现融合，B组28例患者中有26例（93%）实现融合（P = 0.02）。术后2年和3年，B组的颈后疼痛强度也显著低于A组（分别为P = 0.02和0.01）。A组螺钉松动和植入物相关问题的发生率（60%）高于B组（21%）（P = 0.01）。两组之间的其他临床和影像学参数相似。
对于手足徐动型CP引起的CM，与单纯后路融合相比，A-P联合融合术将产生更好的临床和影像学结局。
