摘要
目的评价寰枢椎后路融合角度与术后下位颈椎矢状面曲度之间的联系并确定最佳的寰枢椎固定角度以保护颈椎生理曲度。方法对1995年2月至2005年6月因寰枢椎脱位而行后路C1,C2融合术的92例患者进行术后随访。术前测量颈椎侧位片C1-C2,C2-C7夹角，并且进行术后长期随访，以观察术后随访C1-C2,C2-C7夹角之间的相关性。结果所有患者均获得随访，时间2．0—10．3年，平均5．2年。术前及术后随访时C1-C2,夹角平均值分别为18．4°±9．3°、26．0°±6．8°，差异有统计学意义（t=10．4，P〈0．05）；术前及术后随访时C2-C7夹角平均值分别为14．5°±10．1°、5．6°±12．0°，差异有统计学意义（t=6．0，P〈0．05）；其中术后随访C1-C2固定角度〈20°（10°-20°）共计30例，≥20°（20．00～43．60）共计62例。C1-C2固定角度〈20°者，术后随访C1-C2角度与C2-C7夹角之间无明确的相关性；C1-C2固定角度≥20°者，术后随访C1-C2角度与C2—C7夹角之间存在线性负相关；C1-C2术前、术后随访夹角的变化值与C2-C7术前、术后随访夹角的变化值之间也存在线性负相关。结论寰枢关节行后路手术固定于高度前凸位时将导致术后下位颈椎的脊柱后凸，并且固定角度越大，下位颈椎的后凸程度就越大；为了保持下位颈椎的生理性曲度，手术中应尽量将C1-C2固定的角度控制在10°～20°范围内。
Objective To investigate the association between atlantoaxial （A-A） fusion angle and postoperative subaxial sagittal alignment so that an optimal fusion angle for preservation of physiologic subaxial alignment can be determined. Methods Ninety-two patients with A-A subluxation underwent several types of posterior A-A fusion from February 1995 to June 2005. Angles at C1-C2 and C2-C7 in the neutral position were measured before surgery and at the final follow-up to find out any association between the postoperative C2-C7 angle and the C1-C2 angle. Results All the 92 patients were followed up for 2. 0 to 10. 3 years, with an average of 5.2 years. The mean angles of C1-C2 and C2-C7 before surgery were 18.4° and 14. 5° respectively, and 26. 0°and 5.6° at the final follow-up respectively. In 30 patients, the follow-up angels were less than 20° （range, 10°to 20°）; in 62 patients, the follow-up angels were larger than 20° （range, 20.0°to 43.6°） . Statistics revealed that when the fusion angles of C1-C2 were less than 20°, there was no association between the C1-C2 fixation angel and the postoperative C2-C7 angel; when the fusion angels of C1-C2 were larger than 20°, there was a linear negative association between the C1-C2 fixation angle and the C2-C7 postoperative angle. In addition, there was also a linear negative association between the pre/ post-operative angles of C1-C2 and those of pre/post-operative angles of the C2-C7. Conclusions Surgical fixation of A-A joint in a hyperlordotic position will make the lower cervical spine in a kyphotic sagittal alignment after surgery. The larger the C1-C2 fixation angle, the more kyphotic sagittal alignment of the lower cervical spine. To maintain the physiologic sagittal alignment of the subaxial cervical spine, C1-C2 should be fixed at an optimal fusion angle （range, 10° to 20°）.
出处
《中华创伤骨科杂志》
CAS
CSCD
2008年第11期1036-1039,共4页
Chinese Journal of Orthopaedic Trauma
关键词
寰椎
枢椎
寰枢关节
脱位
脊柱融合术
Atlas
Axis
Atlantoaxial joint
Dislocation
Spinal fusion
