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Abstract：
OBJECTIVE: Cable-dragged reduction and cantilever beam internal fixation can provide promising results in the treatment of atlantoaxial dislocation or instability. However, bilateral atlantoaxial joints bone autografting has not been conducted in this technique. We aim to evaluate the safety and effectiveness of bilateral atlantoaxial joints bone autografting in posterior cable-dragged reduction and cantilever-beam internal fixation.
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.
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.
摘要：
目的：电缆牵引复位和悬臂梁内固定可在治疗寰枢椎脱位或不稳定方面提供有希望的结果。然而,这项技术尚未进行双侧寰枢关节骨自体移植。我们旨在评估双侧寰枢关节骨自体移植在后路缆索牵引复位和悬臂梁内固定中的安全性和有效性。
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。
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。
