Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Orthopedic Surgery, Affiliated Hospital of Yangzhou University, Yangzhou, China.
Orthop Surg. 2022 Jun;14(6):1135-1142. doi: 10.1111/os.13227. Epub 2022 May 7.
To evaluate the safety and efficacy of cervical pedicle screw (CPS) placement with O-arm navigation in the treatment of lower cervical fracture-dislocation.
A retrospective clinical study was performed involving 42 consecutive patients with lower cervical spine fracture-dislocation who underwent CPS fixation surgery with O-arm navigation (CPS group) or received conventional lateral mass screw (LMS) fixation surgery (LMS group) between August 2015 and August 2019. Accuracy of CPS position was evaluated by postoperative CT. The clinical parameters including preoperative and final follow-up Japanese Orthopaedic Association (JOA) score and American Spinal Injury Association (ASIA) Impairment Scale, preoperative Sub-axial Injury Classification (SLIC) score, number of fixation segments, operation time, intraoperative blood loss, injury mechanism, injury location, surgical complications were also assessed between the two groups.
In LMS group, the preoperative SLIC score was 7.5 ± 0.9, ASIA score improvement was 0.8 ± 0.5, JOA score improvement was 3.0 ± 1.8, mean operation time was 204 ± 89 min, intraoperative blood loss was 311 ± 127 ml. In CPS group, the preoperative SLIC score was 7.3 ± 1.2, ASIA score improvement was 0.9 ± 0.5, JOA score improvement was 3.2 ± 2.4, mean operation time is 241 ± 85 min, intraoperative blood loss is about 327 ± 120 ml. There was no significant difference in terms of above clinical parameters between the two groups (P > 0.05), the fixation segments in CPS group (3.5 ± 1.1) were less than that in LMS group (4.2 ± 0.7) (P = 0.037). The accuracy of CPS insertion was evaluated based on postoperative CT. Of all the 118 CPSs, 83 (70.3%) were defined as Grade 0; 27 (22.9%) as Grade 1; eight (6.8%) as Grade 2; and none as Grade 3. CPS malposition rate in this study was 6.8%. In this study, there was no direct intraoperative or postoperative complication caused by CPS or LMS insertion. All the operations were successfully completed in two groups. One of the patients in LMS group presented cerebrospinal fluid leak caused by bone fragment broken of the dural sac, which led to delayed incision healing. CPS group and LMS group both had two patients who suffered pulmonary infection after surgery. A total of 78.6% of the patients showed evidence of neurologic recovery. Satisfactory reduction was achieved in all cases and maintained throughout the follow-up duration.
In the treatment of lower cervical spine fracture-dislocation, cervical pedicle screw insertion with O-arm navigation is a safe and effective method for posterior fixation.
评估 O 臂导航下颈椎椎弓根螺钉（CPS）置入治疗下颈椎骨折脱位的安全性和有效性。
回顾性临床研究纳入 2015 年 8 月至 2019 年 8 月期间采用 O 臂导航下 CPS 固定术（CPS 组）或传统侧块螺钉（LMS）固定术（LMS 组）治疗的 42 例下颈椎骨折脱位患者。术后 CT 评估 CPS 位置准确性。评估两组患者术前及末次随访日本矫形协会（JOA）评分和美国脊柱损伤协会（ASIA）损伤分级、术前轴位损伤分级（SLIC）评分、固定节段数、手术时间、术中出血量、损伤机制、损伤部位、手术并发症等临床参数。
LMS 组术前 SLIC 评分为 7.5±0.9，ASIA 评分改善为 0.8±0.5，JOA 评分改善为 3.0±1.8，平均手术时间为 204±89 min，术中出血量为 311±127 ml。CPS 组术前 SLIC 评分为 7.3±1.2，ASIA 评分改善为 0.9±0.5，JOA 评分改善为 3.2±2.4，平均手术时间为 241±85 min，术中出血量约为 327±120 ml。两组间上述临床参数比较差异均无统计学意义（P＞0.05），CPS 组固定节段数（3.5±1.1）少于 LMS 组（4.2±0.7）（P=0.037）。术后 CT 评估 CPS 置入的准确性。118 枚 CPS 中，83 枚（70.3%）为 0 级；27 枚（22.9%）为 1 级；8 枚（6.8%）为 2 级；无 3 级。本研究中 CPS 定位不良率为 6.8%。本研究中，CPS 和 LMS 置入均未引起直接的术中或术后并发症。两组手术均顺利完成。LMS 组 1 例患者因骨片刺破硬脊膜导致脑脊液漏，导致切口愈合延迟。CPS 组和 LMS 组各有 2 例患者术后发生肺部感染。共有 78.6%的患者出现神经功能恢复迹象。所有病例均获得满意复位，并在随访期间保持稳定。
在治疗下颈椎骨折脱位时，O 臂导航下颈椎椎弓根螺钉置入是一种安全有效的后路固定方法。
