| Background An important surgical method for the treatment of deformity of the cranial-cervical junction area is occipitocervical fusion.The clinical effectiveness has been confirmed in many years of application.Previous studies have shown that the lower cervical curvature changes after the fixation of the occipitocervical junction area,and normal.The inclination T1 S in the crowd was positively correlated with the curvature of the cervical spine,and its influence on the change of cervical curvature after occipitocervical fusion was not reported.PurposeBy measuring the sagittal parameters of the cervical spine before and after occipitocervical fusion in the cranial-cervical junction area.To analyze changes of the lower cervical curvature after occipitocervical fusion and the curvature of the lower cervical vertebra was observed after the occipital neck fusion was fixed.influences.MethodA retrospective analysis was performed on the clinical data of 34 patients who underwent occipito-cervical fusion surgery in the Department of Craniofacial Intersection of the First Affiliated Hospital of Zhengzhou University from June 2016 to December 2017,including 16 male patients and 18 female patients.The patients were 30 to 62 years old with an average of 45.5 years;all patients were followed for a minimum of 12 months with an average of 15.6 months.All patients were diagnosed as malformation of the cranial-cervical junction area,including 12 cases of skull base depression combined with atlantoaxial dislocation,10 cases of skull base depression combined with sacral occlusion,and 12 cases of atlantoaxial dislocation combined with Chiari malformation.;8 cases were treated with one-stage combined anterior orbital lysis,all patients The occipital plate-axial pedicle screw fixation.The sagittal parameters were measured by lateral X-ray of the cervical vertebrae.Each parameterwas measured three times and the average was taken as the final measurement.The selected parameters included imaging parameters:Occipital angle before and after surgery and at the last follow-up.(occipital-C2 angle,O-C2 angle),cervical anterior curvature angle(C2-7 Cobb angle),neck 2-7 vertical axis distance(C2-7 SVA),T1 inclination angle(T1 slope).The clinical effect indicators recorded the cervical spine JOA score of the Japanese Orthopaedic Association,NDI score and VAS score before and at the last follow-up.Statistical analysis was performed on general data such as age,gender,JOA,NDI,and VAS before and after surgery.Group design: According to the preoperative chest 1 tilt angle average,the two groups were divided into two groups(T1 Slop> 26.15 °),group B(T1 Slop <26.15 °),analysis of the two groups after surgery,the last follow-up C2-7 Cobb angles were changed and correlation analysis was performed.Result34 patients underwent successful operation,and no neurological dysfunction and other complications occurred.All patients had improved clinical symptoms.The JOA score improved from 8.62±2.06 to 12.26±1.82,and the NDI score was 26.28 before surgery.The decrease of ±7.29 to 12.85±8.69,the visual VAS score of 3.72±2.10 was improved to 1.14±0.65 at the last follow-up,and the changes were statistically significant(p<0.05).All patients had statistically significant differences(P<0.05)between the preoperative and postoperative paired t-test or rank-sum test for C2-7Cobb angle,Oc-C2 angle,C2-7 SVA and other parameters.Preoperative operation of T1 slope There was no statistical difference in post-change(p=0.86).In the correlation test,preoperative T1 slope was correlated with C2-7 Cobb angle and C2-7SVA,and had no correlation with preoperative Oc-C2 angle.Postoperative Oc-C2 angle and postoperative C2-7 Cobb The angle has a negative correlation,and the postoperative T1 slope has a correlation with the C2-7 Cobb angle and the postoperative Oc-C2 angle.Grouped statistical analysis: There was no statistical difference in the distribution of general data such as age and gender before operation.There were no statistically significant differences in Oc-C2 angle,JOA,NDI and VAS between the two groups before,after and after the last follow-up.There was a statistically significant difference in the degree of C2-7 Cobb angle between the twogroups at the last follow-up.The change of C2-7 Cobb angle in group A was significantly greater than that in group B at the last follow-up.The patients with high T1 S had a greater change of cervical curvature after operation.conclusion1.There is a negative correlation between the occipital angle and the lower cervical curvature after occipitocervical fusion.The increased occipital angle will lead to the reduction of cervical curvature.2.The high T1 S before surgery leads to large changes of cervical curvature after surgery,which can be used as a reference for surgical fixation.Patients with high T1 S can consider reducing the angle of the neck to compensate the curvature. |
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