方法:回顾性研究。
目的:对寰枢椎脱位后的手术失败进行分类,提出修订策略并评估修订手术的临床结果。
背景:随着寰枢椎脱位手术的增加,手术失败的数量逐渐增加。然而,目前有关寰枢椎手术翻修的报道范围有限.关于手术失败的原因仍然缺乏总结,详细的分类系统,并且没有建议的翻修手术策略。
方法:109例寰枢椎脱位后手术失败的患者,根据术后即刻复位和翻修前的融合状态进行分类。减少,减压,通过X线评估翻修手术后的融合状态和结局,CT,MRI和JOA评分。数据采用配对样本t检验和多元逻辑回归分析进行统计分析。
结果:109例患者分为三类失败:非融合非复位(NR-NF,73例),融合不还原(NR-F,19例),和非融合还原(R-NF,17例)。64例患者接受了前路翻修,21后路翻修,和24前后翻修。术后并发症是早期翻修的主要原因。修订后,在所有情况下都实现了完全减压,解剖复位89例,77例JOA评分明显改善,86例实现融合。12例发生手术并发症,3例进行了第二次翻修。
结论:我们发现NR-NF是寰枢关节脱位手术后最常见的失效类型。修订策略可以根据我们对故障的描述性分类来指导,翻修手术应侧重于实现足够的减少,适当的固定和可靠的融合,以优化术后结果。
METHODS: Retrospective
study.
OBJECTIVE: To classify surgical failures following atlantoaxial dislocation, present strategies for revisions, and evaluate the clinical results of revision surgery.
BACKGROUND: With the increase in atlantoaxial dislocation surgery, the number of surgical failures has gradually risen. However, current reports on atlantoaxial surgical revision are limited in scope. There remains a lack of summary regarding the causes of surgical failure, a detailed classification system, and no proposed strategy for revision surgery.
METHODS: A total of 109 cases of failed surgery following atlantoaxial dislocation were classified according to the reduction immediately after surgery and the fusion status before revision. The reduction, decompression, fusion status, and outcomes following revision surgery were evaluated by x-ray, computed tomography, magnetic resonance imaging, and the Japanese Orthopaedic Association score. The data were analyzed statistically with a paired-samples t test and multivariable logistic regression analysis.
RESULTS: The 109 patients were classified into three categories of failure: nonreduction with nonfusion (NR-NF, 73 cases), nonreduction with fusion (NR-F, 19 cases), and reduction with nonfusion (R-NF, 17 cases). Sixty-four patients underwent anterior revision, 21 posterior revision, and 24 anteroposterior revision. Postoperative complications were the primary cause of early revisions. After revision, complete decompression was achieved in all cases, anatomical reduction in 89 cases, significant improvement of Japanese Orthopaedic Association score in 77 cases, and fusion achieved in 86 cases. Twelve cases experienced surgical complications and three underwent a second revision.
CONCLUSIONS: The authors found that NR-NF was the most common type of failure following surgery for atlantoaxial dislocation. Revision strategies can be guided according to the descriptive classification of failure, and revision surgery should focus on achieving adequate reduction, appropriate fixation, and reliable fusion to optimize postsurgical outcomes.