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  • Title: [Relationship between O-EA angle and lower cervical curvature in patients with anterior atlantoaxial dislocation before and after occipitocervical fusion].
    Author: Chen T, Yang X, Xiu P, Song Y.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Apr 15; 35(4):453-457. PubMed ID: 33855829.
    Abstract:
    OBJECTIVE: To investigate the relationship between O-EA angle and lower cervical curvature in patients with anterior atlantoaxial dislocation undergoing occipitocervical fusion, and to analyze the effect of O-EA angle on lower cervical curvature. METHODS: The clinical data of 61 patients with anterior atlantoaxial dislocation undergoing occipitocervical fusion who were admitted between April 2010 and July 2018 and met the selection criteria were retrospectively analyzed. There were 32 males and 29 females, with an age of 14-76 years (mean, 50.7 years). The fixed segment included 19 cases of C 0-C 2, 27 cases of C 0-C 3, 14 cases of C 0-C 4, and 1 case of C 0-C 5. The O-EA angle, C 2-7 Cobb angle, and T 1 tilt angle were measured before operation and at last follow-up. According to the O-EA angle measured at last follow-up, the patients were divided into <95° group (group A), 95°-105° group (group B), and >105° group (group C), and compared the differences of gender, age, fixed segment (short segment was at C 3 and above, long segment was beyond C 3), and C 2-7 Cobb angle. Correlation analysis between the O-EA angle and C 2-7 Cobb angle before operation and at last follow-up, as well as the changes of O-EA angle and C 2-7 Cobb angle between before operation and at last follow-up were analyzed. RESULTS: All 61 patients were followed up 12-24 months, with an average of 22.4 months. There was no significant difference in O-EA angle, C 2-7 Cobb angle, and T 1 tilt angle before operation and at last follow-up ( P>0.05). According to the last follow-up O-EA angle grouping, there were 14 cases in group A, 29 cases in group B, and 18 cases in group C. There was no significant difference in age, gender composition, and fixed segment composition among the three groups ( P>0.05); the differences in C 2-7 Cobb angles among the three groups were significant ( P<0.05), groups A, B, and C showed a gradually increasing trend. The O-EA angle was positively correlated with C 2-7 Cobb angle before operation and at last follow-up ( r=0.572, P=0.000; r=0.618, P=0.000); O-EA angle change at last follow-up was also positively correlated with C 2-7 Cobb change ( r=0.446, P=0.000). CONCLUSION: The O-EA angle of patients with anterior atlantoaxial dislocation is positively correlated with C 2-7 Cobb angle. Too large O-EA angle should be avoided during occipitocervical fixation, otherwise it may accelerate the degeneration of the lower cervical spine. 目的: 探讨寰枢前脱位枕颈融合术患者 O-EA 角与下颈椎曲度的关系及其对下颈椎曲度的影响。. 方法: 回顾分析 2010 年 4 月—2018 年 7 月收治且符合选择标准的 61 例合并寰枢前脱位行枕颈融合术患者临床资料。男 32 例，女 29 例；年龄 14～76 岁，平均 50.7 岁。固定节段：C 0～C 2 19 例，C 0～C 3 27 例，C 0～C 4 14 例，C 0～C 5 1 例。术前及末次随访时测量 O-EA 角、C 2～7 Cobb 角和 T 1 倾斜角；根据末次随访时所测 O-EA 角，将患者分为<95° 组（A 组）、95°～105° 组（B 组）、>105° 组（C 组），比较各组患者性别、年龄、固定节段（在 C 3 及以上为短节段，C 3 以远为长节段）和 C 2～7 Cobb 角。对术前、末次随访时 O-EA 角和 C 2～7 Cobb 角之间，以及二者手术前后的变化值进行相关性分析。. 结果: 61 例患者术后均获随访，随访时间 12～24 个月，平均 22.4 个月。患者术前及末次随访时 O-EA 角、C 2～7 Cobb 角和 T 1 倾斜角比较差异均无统计学意义（ P>0.05）。根据末次随访时 O-EA 角分组，A 组 14 例、B 组 29 例、C 组 18 例。3 组患者年龄、性别构成、固定节段构成比较差异均无统计学意义（ P>0.05）；3 组间 C 2～7 Cobb 角比较差异均有统计学意义（ P<0.05），A、B、C 组呈逐渐增加趋势。术前、末次随访时 O-EA 角与 C 2～7 Cobb 角均成正相关（ r=0.572， P=0.000； r=0.618， P=0.000）；末次随访时 O-EA 角变化与 C 2～7 Cobb 角变化亦成正相关（ r=0.446， P=0.000）。. 结论: 合并寰枢前脱位患者的 O-EA 角与 C 2～7 Cobb 角成正相关，行枕颈固定术中应避免 O-EA 角过大，否则可能加速下颈椎退变。.
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