Department of Orthopedics, Peking University Third Hospital.
Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China.
Clin Spine Surg. 2021 Jul 1;34(6):E308-E314. doi: 10.1097/BSD.0000000000001155.
A retrospective single-center study.
We aimed to compare the clinical outcomes of cervical spine fracture accompanied with ankylosing spondylitis (ASCSF) treated by single posterior approach (PA) and combined anterior-posterior approach (CA) for patients who were followed up for >1 year.
For ASCSF patients, surgical treatment has been widely accepted as a recommendable therapeutic option. But the optimal surgical approach is still under controversy, and few studies have focused on the comparison between PA and CA.
From February 2007 to March 2019, 53 patients were enrolled and divided into the PA group (34 cases) and CA group (19 cases). Their general characteristics and clinical materials were recorded. From the aspects of reduction distance, bone fusion, neurological functional restoration, and postoperative complications, patients' surgical outcomes were evaluated qualitatively and quantitatively.
The reduction degree of dislocation (mean PA=2.05 mm, mean CA=2.36 mm, P=0.94) was close between the 2 groups. Besides, with a similar follow-up period (P=0.10), the rate of bone fusion (both 100%) and neurological functional restoration (PA=31.03%, CA=35.29%, P=0.77) were also without significant difference. The occurrence rate of postoperative complications tended to be higher in the CA group (31.58% vs. 23.53%) but with no significant difference (P=0.52). Nevertheless, the surgical duration time (mean=209.15 min) and blood loss (average=388.91 mL) of PA group were significantly less than CA group (mean duration time=285.34 min, mean blood loss=579.27 mL) (P<0.01).
Compared with to the CA approach and with the equally significant outcome, surgery by single PA was feasible and should be positively recommended for ASCSF patients, especially for those accompanying with a severe chin-on-chest deformity or poor physical conditions which restrain patients from tolerating a long surgery or major surgical trauma.
回顾性单中心研究。
我们旨在比较随访时间＞1 年的强直性脊柱炎伴颈椎骨折（ASCSF）患者接受单一后路（PA）和前后联合入路（CA）治疗的临床结果。
对于 ASCSF 患者，手术治疗已被广泛接受为一种可行的治疗选择。但是，最佳手术入路仍存在争议，很少有研究关注 PA 和 CA 之间的比较。
2007 年 2 月至 2019 年 3 月，共纳入 53 例患者，分为 PA 组（34 例）和 CA 组（19 例）。记录他们的一般特征和临床资料。从复位距离、骨融合、神经功能恢复和术后并发症等方面，定性和定量评估患者的手术结果。
两组脱位的复位程度（PA 组平均为 2.05mm，CA 组平均为 2.36mm，P=0.94）接近。此外，在相似的随访期（P=0.10）内，骨融合率（均为 100%）和神经功能恢复率（PA 组为 31.03%，CA 组为 35.29%，P=0.77）也无显著差异。CA 组术后并发症的发生率（31.58%比 23.53%）虽有增高趋势，但无显著差异（P=0.52）。然而，PA 组的手术时间（平均 209.15min）和出血量（平均 388.91mL）明显少于 CA 组（平均手术时间 285.34min，平均出血量 579.27mL）（P<0.01）。
与 CA 入路相比，PA 入路治疗 ASCSF 同样安全有效，对于伴有严重下颌前伸畸形或身体状况较差的患者，PA 入路应积极推荐，因为这些患者无法耐受长时间手术或较大的手术创伤。
