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Occipito-cervical fusion: review of surgical indications, techniques and clinical outcomes

机译:枕颈融合:外科手术适应症,技术和临床结果的回顾

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STUDY DESIGN: A retrospective review of patients undergoing single-surgeon occipito-cervical fusion. OBJECTIVE: The aim of this study is to evaluate the surgical indications, techniques and clinical outcomes of occipito-cervical fusion, including C2 fixation methods and complications. MATERIALS AND METHOD: Thirty-four consecutive patients (16 males, 18 females) who underwent occipito-cervical fusion were reviewed. The indications for fusion were instability due to inflammatory diseases (13), trauma (9), congenital abnormalities (9), infections (2) and tumours (1). Nine patients (all but 1 paediatric) underwent fusion with bone grafting and halo immobilisation. Twenty-five patients underwent posterior instrumented fusion. Halo removal was performed after 6 weeks and soft collars were worn for 6 weeks in the instrumented group. Surgical techniques and clinical outcomes (stability, fusion, complications) were reviewed. RESULTS: Clinical and radiological fusion was attained in all patients available for follow-up, with an average of 2.7 months in the uninstrumented group and 5.2 months in the instrumented group. All fusions resulted in resolution of preoperative pain and an improvement in pre-operative neurology. Two patients demised in the acute postoperative period as a result of the underlying pathology. Eighteen patients required simultaneous decompressions. No instrumentation failures occurred. Superficial wound sepsis occurred in 4 patients, one subsequently requiring instrumentation removal. CONCLUSION: Occipito-cervical fusion is a safe and reliable procedure, predictably providing stability and improvement in preoperative pain and neurology. Multiple cervical fixation options are available according to surgeon preference and anatomical variants.
机译:研究设计:回顾性研究接受单刀枕颈融合术的患者。目的:本研究旨在评估枕颈融合术的手术指征,技术和临床结果,包括C2固定方法和并发症。材料与方法:回顾性分析了34例行枕颈融合术的患者(男16例,女18例)。融合的指征是由于炎症性疾病(13),创伤(9),先天性异常(9),感染(2)和肿瘤(1)而引起的不稳定。 9名患者(除1名儿科患者外,其余全部患者)均接受了植骨和固定环的融合术。 25例患者接受了后路器械融合术。在仪器组中,在6周后进行光晕消除,并在6周内佩戴软项圈。回顾了手术技术和临床结局(稳定性,融合性,并发症)。结果:所有可进行随访的患者均达到了临床和放射学融合,非仪器组平均为2.7个月,仪器组为5.2个月。所有融合术均能缓解术前疼痛并改善术前神经系统。由于潜在的病理学原因,两名患者在术后急性期死亡。 18名患者需要同时进行减压。没有发生仪器故障。浅表脓毒症发生在4例患者中,一名随后需要移除器械。结论:枕颈融合术是一种安全可靠的方法,可预测地提供术前疼痛和神经病学方面的稳定性并改善病情。根据外科医生的喜好和解剖学变化,可以选择多种颈椎固定方法。

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