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学科主题临床医学
Treatment of atlantoaxial dislocations among patients with cervical osseous or vascular abnormalities utilizing hybrid techniques
Wang, Shenglin1; Tian, Yinglun1; Diebo, Bassel G.2; Horn, Samantha R.3; Passias, Peter G.3
通讯作者Wang, Shenglin(1)
关键词atlantoaxial dislocation osseous deformity vascular deformity craniovertebral junction hybrid fixations asymmetric fixation C-2 laminar screw cervical pedicle screw spinous process screw myelopathy surgical technique
刊名JOURNAL OF NEUROSURGERY-SPINE
2018-08-01
DOI10.3171/2017.12.SPINE17632
29期:2页:135-143
收录类别SCI
文章类型Article
WOS标题词Science & Technology
类目[WOS]Clinical Neurology ; Surgery
研究领域[WOS]Neurosciences & Neurology ; Surgery
关键词[WOS]PEDICLE SCREW FIXATION ; C2 PEDICLE ; LAMINAR SCREW ; FUSION ; CLASSIFICATION ; ATLAS ; PLATE
英文摘要

OBJECTIVE Most cervical fixations for atlantoaxial dislocation (AAD) are bilateral and symmetric; however, in the setting of osseous and vascular deformity at the craniovertebral junction, asymmetrical and hybrid fixations are used as "salvage" techniques. Because of the rarity of these cases, hybrid cervical fixations for AAD have not been fully explored. The aim of this study was to evaluate the clinical feasibility and outcomes of posterior hybrid cervical fixations for AAD.

METHODS Twenty-one AAD cases were retrospectively studied; 18 had cervical myelopathy with Japanese Orthopaedic Association (JOA) scores ranging from 9 to 16 (mean 13.5). Hybrid fixation techniques included unilateral pedicle screws, transarticular screws, C-2 laminar screws, cervical lateral mass screws, and spinous process screws. During the same period, 82 AAD cases, treated using symmetric traditional fixations, were analyzed as controls.

RESULTS Atlantoaxial fixation was performed in 11 cases, while occiput-cervical fixation was used in 10 cases. All cases achieved solid osseous fusion. Anatomical reduction was achieved in 20 cases (95.2%). All 18 cases with myelopathy showed postoperative improvement, with JOA scores ranging from 13 to 17 (mean 15.5). Three cases (14.2%) experienced complications, including delayed wound healing, CSF leakage, and fixation loosening. Hybrid fixation techniques showed significantly greater estimated blood loss when compared with controls (208.1 +/- 19.30 ml vs 139.63 +/- 8.75 ml, p = 0.001). Operative duration (125.38 +/- 6.29 min vs 119.41 +/- 3.77 min, p = 0.464), complication rates (14.3% vs 4.9%, p = 0.148), and JOA improvement rates (61% +/- 7% vs 49% +/- 4%, p = 0.161) showed no significant differences.

CONCLUSIONS For ADD with osseous or vascular deformity, posterior cervical reduction and stabilization can be achieved using hybrid techniques, resulting in comparable clinical results to symmetric traditional fixation.

语种英语
WOS记录号WOS:000440474700003
通讯作者邮箱pkuwsl@126.com
第一作者单位Peking Univ, Hosp 3, Orthopaed Dept, Beijing, Peoples R China
通讯作者单位Peking Univ, Hosp 3, Orthopaed Dept, Beijing, Peoples R China
ISSN1547-5654
引用统计
文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/142625
专题北京大学第三临床医学院_骨科
作者单位1.Peking Univ, Hosp 3, Orthopaed Dept, Beijing, Peoples R China;
2.Suny Downstate Med Ctr, Brooklyn, NY 11203 USA;
3.NYU, Hosp Joint Dis, New York, NY USA
推荐引用方式
GB/T 7714
Wang, Shenglin,Tian, Yinglun,Diebo, Bassel G.,et al. Treatment of atlantoaxial dislocations among patients with cervical osseous or vascular abnormalities utilizing hybrid techniques[J]. JOURNAL OF NEUROSURGERY-SPINE,2018,29(2):135-143.
APA Wang, Shenglin,Tian, Yinglun,Diebo, Bassel G.,Horn, Samantha R.,&Passias, Peter G..(2018).Treatment of atlantoaxial dislocations among patients with cervical osseous or vascular abnormalities utilizing hybrid techniques.JOURNAL OF NEUROSURGERY-SPINE,29(2),135-143.
MLA Wang, Shenglin,et al."Treatment of atlantoaxial dislocations among patients with cervical osseous or vascular abnormalities utilizing hybrid techniques".JOURNAL OF NEUROSURGERY-SPINE 29.2(2018):135-143.
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