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C1-C2 Pedicle Screw Fixation for Pediatric Atlantoaxial Dislocation: Initial Results and Long-term Follow-up.

C1-C2 椎弓根螺钉固定治疗儿童寰枢椎脱位: 初步结果和长期随访。

  • 影响因子:0
  • DOI:10.1097/BPO.0000000000001111
  • 作者列表:"Chen ZD","Wu J","Lu CW","Zeng WR","Huang ZZ","Lin B
  • 发表时间:2020-02-01
Abstract

BACKGROUND:There are few studies reporting the use of atlantoaxial pedicle screws and the long-term effects of C1-C2 posterior fusion in children. Our study is to investigate the initial results of C1-C2 pedicle screw fixation for pediatric atlantoaxial dislocation (AAD) and assessed spontaneous change of postoperative radiography after a long-term follow-up period. METHODS:Posterior pedicle screw fixations were performed in 21 pediatric patients with AAD. All the patients underwent implant removal 1 year after their initial surgery and had regular follow-up with an average duration of 76.4 months (range, 52 to 117 mo). Clinical and radiographic data were then collected and compared. RESULTS:Frankel Grade was significantly improved at 3 months follow-up compared with pretreatment values. All patients had good bony fusion at a mean of 4.2±0.9 months (range, 3 to 6 mo) after treatment. None of the patients experienced worsening neurological symptoms or injury to the vertebral artery. However, 2 cases experienced minor complications. Following removal of the implants, no spinal deformities or subaxial instabilities were found. The mean angle of sagittal curvature increased from 12.1±2.4 degrees (range, 0 to 22 degrees) immediately postoperatively to 19.1±2.7 degrees (range, 6 to 31 degrees) at the final follow-up (P>0.05). CONCLUSIONS:The results demonstrated that C1-C2 pedicle screw fixation could achieve satisfactory initial results for the management of the pediatric AAD. Moreover, removal of the metal implant after bony fusion did not increase the risk of spinal deformity or subaxial instability at long-term follow-up.

摘要

背景: 很少有研究报道使用寰枢椎椎弓根螺钉和儿童C1-C2 后路融合的长期影响。我们的研究是调查C1-C2 椎弓根螺钉固定治疗儿童寰枢椎脱位 (AAD) 的初步结果,并评估长期随访后术后x线片的自发变化。 方法: 对 21 例AAD患儿进行后路椎弓根螺钉内固定。所有患者在初次手术后 1 年接受种植体取出术,并定期随访,平均随访时间为 76.4 个月 (52 ~ 117 mo)。然后收集并比较临床和影像学资料。 结果: 3 个月随访时Frankel分级较治疗前值明显改善。所有患者治疗后平均 4.2 ± 0.9 个月 (3 ~ 6 个月) 骨性融合良好。所有患者均未出现神经症状恶化或椎动脉损伤。但 2 例出现轻微并发症。取出植入物后,未发现脊柱畸形或轴下不稳定。矢状面曲率的平均角度从术后即刻的 12.1 ± 2.4 度 (范围,0 至 22 度) 增加到 19.1 ± 2.7 度 (范围,6 至 31 度) 最终随访时 (P>0.05)。 结论: 结果表明,C1-C2 椎弓根螺钉内固定治疗儿童AAD可取得满意的初步效果。此外,在长期随访中,骨性融合后取出金属植入物不会增加脊柱畸形或轴下不稳定的风险。

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发表时间:2020-01-01
DOI:10.1002/acr.23824
作者列表:["Chen SK","Liao KP","Liu J","Kim SC"]

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