Arita Takafumi, Kawano Osamu, Sakai Hiroaki, Morishita Yuichiro, Masuda Muneaki, Hayashi Tetsuo, Kubota Kensuke, Maeda Takeshi, Nakashima Yasuharu, Yokota Kazuya
Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan.
Departments of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka, 812-8582, Japan.
Heliyon. 2024 Mar 15;10(6):e27952. doi: 10.1016/j.heliyon.2024.e27952. eCollection 2024 Mar 30.
The objective of this study was to examine if halo vest fixation provides sufficient stabilization of cervical spine alignment to endorse its use through intraoperative positional changes in patients with cervical spine instability.
The subjects of this study were 14 patients with cervical spine instability who were immobilized in halo vests until they underwent subsequent internal fixation surgery. After induction of anesthesia, the patients in halo vests were repositioned from the supine position to the prone position. The halo ring was fixed to the surgical table and the dorsal struts and vest were removed for surgery. Radiographs obtained in the preoperative sitting position and intraoperative prone position were compared for the following measures of cervical alignment: O-C2 angle, C2-C6 angle, pharyngeal inlet angle (PIA), atlantodental interval (ADI), Redlund-Johnell (R-J) value as a measure of O-C2 length, O-C6 length, and O-C2 length/O-C6 length (%).
There were no significant differences in O-C2 angle, C2-C6 angle, PIA, ADI, or O-C2 length/O-C6 length (%). However, the R-J value and O-C6 length were significantly higher in the intraoperative prone position than in the preoperative sitting position. None of the patients presented with any complications, including dysphagia or neurological deterioration.
Our results suggest that when patients are repositioned to the prone position while immobilized in halo vests, the cervical spine is distracted in the cephalocaudal direction across all cervical segments but the cervical alignment is sufficiently maintained. Halo vests are a highly effective external fixation method for patients with cervical spine instability, allowing for a safe repositioning to the prone position for surgery while preserving cervical alignment and preventing neurological deterioration.
本研究的目的是探讨头环背心固定是否能为颈椎排列提供足够的稳定性，以支持其在颈椎不稳定患者术中体位改变时的应用。
本研究的受试者为14例颈椎不稳定患者，他们在接受后续内固定手术前一直使用头环背心固定。麻醉诱导后，将穿着头环背心的患者从仰卧位重新安置为俯卧位。将头环固定在手术台上，拆除背撑和背心以进行手术。比较术前坐位和术中俯卧位获得的X线片，以测量以下颈椎排列指标：枕骨至第二颈椎（O-C2）角、第二颈椎至第六颈椎（C2-C6）角、咽入口角（PIA）、寰齿间距（ADI）、作为O-C2长度测量指标的Redlund-Johnell（R-J）值、O-C6长度以及O-C2长度/O-C6长度（%）。
O-C2角、C2-C6角、PIA、ADI或O-C2长度/O-C6长度（%）均无显著差异。然而，术中俯卧位的R-J值和O-C6长度显著高于术前坐位。所有患者均未出现任何并发症，包括吞咽困难或神经功能恶化。
我们的结果表明，当患者穿着头环背心固定时重新安置为俯卧位，颈椎在所有颈椎节段的头尾方向上均有牵张，但颈椎排列得到充分维持。头环背心是颈椎不稳定患者一种高效的外固定方法，可安全地重新安置为俯卧位进行手术，同时保持颈椎排列并预防神经功能恶化。
