METHODS: In this retrospective study, we included 14 patients with a minimum 24-month follow-up from December 2019 to September 2020. The granular bone harvested from the iliac crest was packed into the bilateral atlantoaxial joints of 14 patients in posterior cable-dragged reduction and cantilever-beam internal fixation. X-ray imaging and cervical computed tomography (CT) were performed during follow-up. The time required for bone fusion was recorded. The clinical outcomes were evaluated using the JOA scores, NDI, and VAS scores. Mann-Whitney U test, the chi-squared test, or the Fisher exact test were used to compare the two groups regarding patient characteristics, clinical outcomes, bone fusion rates, and cervical sagittal alignment.
RESULTS: The operations were successfully performed in all patients without any intraoperative complications. The mean operation time was (169.64 ± 20.91) minutes, and the intraoperative blood loss was (130.71 ± 33.62) mL. All patients received satisfactory reductions and firm bony fusion at the final follow-up. The fusion rates were 64.29% in the atlantoaxial joints and 21.43% in post bone graft area at 3 months postoperatively, and a significant difference was observed (p = 0.022). Besides, the cervical sagittal alignment in all patients was well maintained in the last follow-up compared to preoperatively. Importantly, a complete bony fusion in the atlantoaxial joints was observed in all patients. Moreover, the JOA, NDI, and VAS scores had improved significantly at the last follow-up.
CONCLUSIONS: Bone autografting of the bilateral atlantoaxial joints is a safe and effective technique to increase bone fusion rates, shorten bone fusion time, and reduce complication rates when the cable-dragged reduction and cantilever beam internal fixation approach is used. Therefore, it is a cost-effective surgical procedure for treating patients with atlantoaxial dislocation or instability.
方法:在这项回顾性研究中,我们纳入了2019年12月至2020年9月至少24个月随访的14例患者.在后路电缆牵引复位和悬臂梁内固定中,从the骨收获的颗粒状骨被填充到14例患者的双侧寰枢关节中。随访期间进行了X射线成像和宫颈计算机断层扫描(CT)。记录骨融合所需的时间。使用JOA评分评估临床结果,NDI,和VAS评分。Mann-WhitneyU测试,卡方检验,或Fisher精确检验用于比较两组患者特征,临床结果,骨融合率,和宫颈矢状面对齐。
结果:所有患者均成功完成手术,无任何术中并发症。平均手术时间(169.64±20.91)分钟,术中出血量为(130.71±33.62)mL。在最后的随访中,所有患者均获得了令人满意的减少和牢固的骨融合。术后3个月,寰枢关节的融合率为64.29%,植骨面积为21.43%,并且观察到显著差异(p=0.022)。此外,与术前相比,末次随访中所有患者的宫颈矢状面对齐均维持良好.重要的是,所有患者均观察到寰枢关节完全骨融合。此外,JOA,NDI,最后一次随访时VAS评分有显著改善.
结论:双侧寰枢关节的骨自体移植是一种安全有效的技术,可以提高骨融合率。缩短骨融合时间,并降低并发症的发生率时,使用电缆拖动复位和悬臂梁内固定方法。因此,对于治疗寰枢椎脱位或不稳定患者,这是一种经济有效的手术方法。