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首页> 外文期刊>Neurocirugia >Artrodesis posterior C1-C2: Experiencia en fijación transarticular e interarticular en 36 pacientes
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Artrodesis posterior C1-C2: Experiencia en fijación transarticular e interarticular en 36 pacientes

机译：C1-C2后关节固定术：36例经关节和关节间固定的经验

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Objective. The stabilization of C1-C2 segment has evolved with the appearance of several techniques from sublaminar, transarticular or interarticular fixation and over recent years with the introduction of neuronavegation systems. The aim of the study was to review patients treated in our center with transarticular and interarticualr fixation and compare the results obtained with both techniques. Methods. Thirty six patients with C1-C2 instability that required a surgical fixation between 1995-2008 were retrostpectively analized. The causes of instability were principaly traumatic (18 cases) or degeneritive (16) and two cases of neoplasic lesions. In the first period (1995-2001) 20 patients were treated with transarticular fixation (Magerl's technique), and later (2002-2008) with interarticular fixation (Goel-Harms technique) in another 16 patients. Data was obtainned regarding complications, radiological evolution and clinical results (EVA pain score) and functionals (PROLO score) at 3, 6, 12 and >12 months post-op, as well as post-op cervical mobility and signs of bone fusion. A good result was considered if clinical improvement existed with decrease in EVA pain score > 5 points and funcional if a PROLO score > 4, regular if EVA decreased but <5 and PROLO <3 , and bad if there was no clinical or functional improvement. The results were statistically compared between both techniques. Results. Of the 20 patients treated with transarticular fixation, good results were obtained in 17 cases (85%) , regular in 2 (10%), and bad in 1 (5%). Complications included 1 case of vertebral artery lesion and 3 screw misplacements, one case in contact with vertebral artery. Regarding those treated with interarticualr fixation, in 14 (89%), good results were obtained, regular in 2 (12.5%) with 1 case of screw misplacement and another of postsurgical infection. No statistical significant differences were recorded between both techniques, although in those treated with interarticular fixation there was a higher rate of bone fusion and no cases of vertebral arterial lesions were recorded. Conclusions. Transarticular and interarticular C1C2 fixation is safe and provides a high rate of good results with few complications. The introduction of neuronavigation systems can increase the efficacy and safety of these techniques.
机译：目的。 C1-C2节段的稳定已随着板层下，经关节或关节间固定的几种技术的出现而发展，并且近年来随着神经探伤系统的引入而发展。这项研究的目的是回顾在我们中心接受经关节和关节间固定治疗的患者，并比较两种技术获得的结果。方法。回顾性分析了1995-2008年间需要手术固定的36例C1-C2不稳定性患者。不稳定的原因主要是外伤性（18例）或退行性病变（16例）和两例赘生物性病变。在第一阶段（1995-2001年），有20例患者接受了经关节内固定（Magerl技术）治疗，随后（2002-2008年）接受了关节间内固定（Goel-Harms技术）治疗的其他16例患者。术后3、6、12和> 12个月获得了有关并发症，放射学演变和临床结果（EVA疼痛评分）和功能（PROLO评分）以及术后宫颈移动性和骨融合迹象的数据。如果EVA疼痛评分降低> 5分，并且如果PROLO评分> 4降低功能，则临床改善存在良好效果;如果EVA降低但<5且PROLO <3，则正常;如果没有临床或功能改善，则不良。将两种技术的结果进行统计学比较。结果。在经关节内固定治疗的20例患者中，17例（85％）取得了良好的效果，2例（10％）正常，1例（5％）较差。并发症包括1例椎动脉病变和3枚螺钉错位，1例与椎动脉接触。对于采用关节内固定治疗的患者，有14例（89％）获得了良好的效果，其中2例（12.5％）中有1例发生螺钉错位和另一例术后感染，取得了良好的效果。两种技术之间均未发现统计学上的显着差异，尽管在关节间固定治疗中，骨融合的发生率更高，并且未记录到椎动脉病变的病例。结论。经关节间和关节间C1C2固定是安全的，并提供了较高的良好结果率，且并发症很少。神经导航系统的引入可以提高这些技术的有效性和安全性。

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