摘要
目的设计3D打印解剖型寰枢椎侧块融合器并探讨其在寰枢椎融合术中的安全性和临床疗效。方法回顾性分析2022年11月至2024年10月于南昌大学第一附属医院接受寰枢椎融合术治疗的89例寰枢椎脱位患者资料,其中48例行自体骨植骨(植骨组)、41例行3D打印寰枢椎侧块融合器植入(融合器组)。植骨组男31例、女17例,年龄57.0(41.5,68.5)岁(范围7~79岁);融合器组男22例、女19例,年龄53.0(39.5,71.5)岁(范围14~80岁)。记录两组患者术前和术后6个月的影像学参数,包括寰枢椎侧块间隙高度(lateral mass interval height,LMIH)、寰齿前间距(atlanto-dens interval,ADI)、双侧寰齿侧间距不对称值(odontoid lateral mass interval asymmetry,OLMIA)、寰枢椎水平旋转角(median inter-atlantoaxial rotation angle,MIA)、枢椎-斜坡角(C_(2)-clivus angle,CCA),以及疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分。记录两组患者术后6个月骨融合率以及并发症情况。结果所有患者均获得随访,随访时间为(8.3±2.1)个月(范围6~12个月)。植骨组患者术前LMIH、ADI、OLMIA、MIA、CCA分别为(2.0±0.8)mm、(4.3±1.9)mm、(4.2±1.9)mm、8.6°±6.6°、142.8°±14.2°,术后6个月分别改善至(4.2±1.4)mm、(1.7±0.7)mm、(1.0±0.6)mm、2.8°±1.6°、145.8°±9.0°,差异均有统计学意义(P<0.05)。融合器组患者术前LMIH、ADI、OLMIA、MIA、CCA分别为(2.3±0.6)mm、(5.5±2.3)mm、(3.8±1.4)mm、7.0°±4.1°、131.4°±14.4°,术后6个月分别改善至(6.0±1.2)mm、(2.1±0.8)mm、(0.7±0.5)mm、2.4°±1.7°、141.7°±11.1°,差异均有统计学意义(P<0.05)。融合器组患者术后6个月LMIH高于植骨组,差异有统计学意义(t=5.374,P<0.05),两组手术前后其余影像学参数的差异均无统计学意义(P>0.05)。植骨组术前VAS、JOA评分分别为(6.2±1.3)分、(10.3±1.7)分,术后6个月改善至(3.2±0.8)分、(14.3±1.3)分,差异均有统计学意义(P<0.05)。融合器组术前VAS、JOA评分分别为(6.4±1.0)分、(9.1±1.3)分,术后6个月改善至(3.0±0.9)分、(14.4±1.3)分,差异均有统计学意义(P<0.05)。两组手术前后VAS、JOA评分的差异均无统计学意义(P>0.05)。两组患者术后6个月骨融合率达均为100%。植骨组1例术中出现轻度椎动脉损伤、3例术后第1天出现C_(2)神经根麻痹,融合器组未见并发症。结论自体骨植骨和寰枢椎侧块融合器植入均取得良好的复位效果,疼痛和功能状态较术前改善。与植骨相比,解剖型寰枢椎侧块融合器植入后侧块间隙更高,可能为寰枢椎提供更稳定的支撑。
Objective To design an anatomically-shaped 3D-printed lateral mass fusion device for atlantoaxial joints and analyze its safety and clinical efficacy in atlantoaxial surgery.Methods A retrospective analysis was conducted on data from 89 patients with atlantoaxial dislocation who underwent atlantoaxial fusion at the First Affiliated Hospital of Nanchang University from November 2022 to October 2024.Among them,48 patients underwent autologous bone grafting(bone graft group),and 41 patients received implantation of a 3D-printed lateral mass fusion device for atlantoaxial joints(fusion device group).In the bone graft group,there were 31 males and 17 females,with a median age of 57.0(41.5,68.5)years(range:7-79 years).In the fusion device group,there were 22 males and 19 females,with a median age of 53.0(39.5,71.5)years(range:14-80 years).Radiographic parameters were recorded preoperatively and at 6 months postoperatively in both groups,including the lateral mass interval height(LMIH),atlanto-dens interval(ADI),odontoid lateral mass interval asymmetry(OLMIA),median inter-atlantoaxial rotation angle(MIA),C_(2)-clivus angle(CCA),visual analogue scale(VAS)score,and Japanese Orthopaedic Association(JOA)score.The bone fusion rate at 6 months postoperatively and the incidence of complications during follow-up were also recorded in both groups.Results All patients were followed up,with a follow-up duration of 8.3±2.1 months(range:6-12 months).In the bone graft group,the preoperative LMIH,ADI,OLMIA,MIA,and CCA were 2.0±0.8 mm,4.3±1.9 mm,4.2±1.9 mm,8.6°±6.6°,and 142.8°±14.2°,respectively,which improved to 4.2±1.4 mm,1.7±0.7 mm,1.0±0.6 mm,2.8°±1.6°,and 145.8°±9.0°postoperatively,respectively,with all differences being statistically significant(P<0.05).In the fusion device group,the preoperative LMIH,ADI,OLMIA,MIA,and CCA were 2.3±0.6 mm,5.5±2.3 mm,3.8±1.4 mm,7.0°±4.1°,and 131.4°±14.4°,respectively,which improved to 6.0±1.2 mm,2.1±0.8 mm,0.7±0.5 mm,2.4°±1.7°,and 141.7°±11.1°postoperatively,respectively,with all differences being statistically significant(P<0.05).The LMIH at 6 months postoperatively was higher in the fusion device group than in the bone graft group,with a statistically significant difference(t=5.374,P<0.05).There were no statistically significant differences in the other preoperative and postoperative radiographic parameters between the two groups(P>0.05).The preoperative VAS and JOA scores in the bone graft group were 6.2±1.3 and 10.3±1.7,respectively,which improved to 3.2±0.8 and 14.3±1.3 postoperatively,with all differences being statistically significant(P<0.05).The preoperative VAS and JOA scores in the fusion device group were 6.4±1.0 and 9.1±1.3,respectively,which improved to 3.0±0.9 and 14.4±1.3 postoperatively,with all differences being statistically significant(P<0.05).There were no statistically significant differences in the preoperative and postoperative VAS and JOA scores between the two groups(P>0.05).The bone fusion rate at 6 months postoperatively was 100%in both groups.In the bone graft group,there was 1 case of mild vertebral artery injury and 3 cases of C_(2)nerve root palsy,while no complications were observed in the fusion device group.Conclusion sBoth autologous bone grafting and implantation of the lateral mass fusion device for atlantoaxial joints achieved good reduction effects,with improvements in pain and functional status compared to the preoperative state.Compared with bone grafting,the anatomically-shaped lateral mass fusion device for atlantoaxial joints provided a higher LMIH,potentially offering more stable support for the atlantoaxial joints.
作者
单越
潘志敏
张财原
姚浩群
Shan Yue;Pan Zhimin;Zhang Caiyuan;Yao Haoqun(Department of Orthopaedics,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)
出处
《中华骨科杂志》
北大核心
2026年第3期184-190,共7页
Chinese Journal of Orthopaedics
关键词
寰枢关节
脱位
治疗结果
寰枢侧块关节
融合器
Atlanto-axial joint
Dislocations
Treatment outcome
Atlanto-axial lateral mass joint
Cage
