Meng Y, Sheng X Q, Wang B Y, Ding C, Hong Y, Liu H
Departement of Orthopaedics of West China Hospital, Sichuan University, Chengdu 610041, China.
West China School of Nursing, Sichuan University/Department of Operating Room, Sichuan University, Chengdu 610041, China.
Zhonghua Yi Xue Za Zhi. 2022 Nov 22;102(43):3437-3442. doi: 10.3760/cma.j.cn112137-20220426-00933.
To assess the clinical impact of direct two-step distraction reduction (TSDR) for basilar invagination (BI) with atlantoaxial dislocation (AAD). Retrospective analysis was conducted on the clinical data of patients who underwent TSDR and occipitocervical fusion in West China Hospital between October 2013 and March 2021. Depending on whether the preoperative decrease was greater than 50% on preoperative hyperextension X-rays, the patients were split into two groups. The neurological function [Japanese Orthopedic Association (JOA) score], atlantodens interval (ADI), the distance of odontoid process beyond McRae Line (ML) and Wackenheim Line (WL), cervicomedullary angle (CMA), O-C angle (OC2A), and complications incidence were compared between two groups preoperatively and postoperatively. There were 12 men and 23 women among the 35 patients with BI and AAD, and the age ranged from 28 to 71 years, with an mean age of (52.0±13.4) years. In the preoperative reduction ≥50% group, there were 4 males and 9 females with an average age of (54.0±13.8) years; in the preoperative reduction <50% group, there were 8 males and 14 females with a mean age of (50.9±13.4) years. All the patients were followed-up for a mean time of (23.3±13.4) months. There was no significant difference in age, gender, bleeding, length of hospital stay and follow-up time between the two groups (all >0.05). The JOA score, ADI, WL, ML and CMA of 35 patients were significantly improved when compared with those before operation (all <0.05). The reduction degree of ADI, ML and WL was more than 80% in 31 cases (88.57%), 30 cases (85.71%) and 31 cases (88.57%), respectively. There was no significant difference in postoperative ADI, ML and WL between the two groups (all >0.05). All patients had no incision infection, no loosening or breakage of the internal fixators. Dysphagia occurred in 3 patients, non-fusion happened in 1 patient, but no instability in X-ray of cervical dynamic position was found, no loosening or displacement occurred in internal fixators, and partial spontaneous fusion occurred between atlantoaxial lateral mass joints. For BI with AAD without atlantoaxial bony connection or serious atlantoaxial facet joint inclination, TSDR could obtain satisfactory reduction degree. The reduction degree on preoperative hyperextension X-ray doesn't affect the degree of intraoperative reduction.
评估直接两步撑开复位（TSDR）治疗合并寰枢椎脱位（AAD）的基底凹陷（BI）的临床效果。对2013年10月至2021年3月在华西医院接受TSDR及枕颈融合术的患者临床资料进行回顾性分析。根据术前过伸位X线片上复位程度是否大于50%，将患者分为两组。比较两组患者术前及术后的神经功能[日本骨科协会（JOA）评分]、寰齿间距（ADI）、齿突超出McRae线（ML）和Wackenheim线（WL）的距离、颈髓角（CMA）、O-C角（OC2A）及并发症发生率。35例合并BI和AAD的患者中，男12例，女23例，年龄28～71岁，平均年龄（52.0±13.4）岁。术前复位≥50%组，男4例，女9例，平均年龄（54.0±13.8）岁；术前复位<50%组，男8例，女14例，平均年龄（50.9±13.4）岁。所有患者平均随访时间为（23.3±13.4）个月。两组患者在年龄、性别、出血量、住院时间及随访时间方面比较，差异均无统计学意义（均>0.05）。35例患者术后JOA评分、ADI、WL、ML及CMA较术前均显著改善（均<0.05）。31例（88.57%）、30例（85.71%）及31例（88.57%）患者的ADI、ML及WL复位程度分别超过80%。两组患者术后ADI、ML及WL比较，差异无统计学意义（均>0.05）。所有患者均无切口感染，内固定物无松动或断裂。3例患者出现吞咽困难，1例患者发生未融合，但颈椎动力位X线片未见不稳定表现，内固定物无松动或移位，寰枢外侧块关节间部分出现自发融合。对于无寰枢椎骨性连接或严重寰枢关节面倾斜的合并AAD的BI，TSDR可获得满意的复位程度。术前过伸位X线片上的复位程度不影响术中复位程度。
