寰枢椎融合与颈枕融合治疗上颈椎疾患的临床疗效比较

目的 探讨寰枢椎融合与颈枕融合在治疗上颈椎疾患的优劣性,并予指导临床内固定方式的选择.方法 我院2007年3月至2011年5月共收治52例上颈椎疾患行颈后路椎弓根钉固定技术的患者,男35例,女17例,年龄16～ 69岁,平均46岁.其中齿状突骨折21例,不稳定Hangman骨折18例,枕寰枢椎发育异常4例,Jefferson骨折3例,类风湿性关节炎伴寰枢椎脱位2例,AndersonⅡ型合并寰椎后弓骨折2例,寰椎椎管内巨大神经鞘瘤1例,枢椎齿状突基底部陈旧性骨折伴寰枢椎半脱位1例.其中36例患者合并不同程度颈脊髓损伤.脊髓损伤按Frankel分级：A级2例,B级5例,C级3例,D级6例,E级20例.根据融合节段不同分别行颈枕融合（A组）11例；寰枢椎融合（B组）41例.结合JOA法及颈部活动丢失度来评估患者临床疗效,两组病例年龄、术前JOA评分、术前颈椎活动度无统计学差异.结果 所有患者均顺利完成手术,术中、术后未出现并发症,均获得12 ～46个月随访,平均21.3个月.两组病例术后JOA评分无统计学差异（P＞0.05）,但侧屈、旋转、屈伸活动丢失率两两比较差异有统计学意义（P＜0.05）,寰枢椎融合较颈枕融合后颈部活动丢失率明显较低（P＜0.05）.术后复查X线见植骨融合,无内固定物松动或断钉现象.结论 寰枢椎融合及颈枕融合均能取得满意的植骨融合和神经症状缓解,但相比枕颈融合,寰枢椎融合对颈椎的屈伸活动度影响较小,应为上颈椎疾患的首选手术方式.但针对某些必须行颈枕融合的病例需严格掌握适应证,结合病因采用相应的手术方式和内固定类型.

Comparative study of atlanto-axial fusion versus craniocervial fusion in treatment of upper cervical spine affection

d Objective To explore the superior and interior of aflantoaxial fusion and occipitiocervical fusion in treatment of upper cervical disease, and to guide the choice of clinical internal fixation methods. Methods 52 cases with upper cervical disease were performed with posterior pedicle screw fixation from 2007. 3 to 2011.5 in our hospital. There were 35 males and 17 females, aged from 16 to 69 years With an average of 46 years, which odontoid fracture in 21 cases, 18 cases of unstable Hangmans fracture,4 cases of pillow aflantoaxial dysplasia, 3 cases of Jefferson fracture ,2 cases of rheumatoid arthritis with atlantoaxial dislocation,Anderson Ⅱ-type merger atlas posterior archfractures in 2 cases, the huge atlas intraspinal schwannoma cases, the odontoid base of old fracture with atlantoaxial subluxation one cases. 36 cases of patients with different degrees cervical spinal cord injury. Spinal injure was graded according to Frankel scale：A in 2 cases, B in 5 cases, C in 3 cases, D in 6 cases and E in 20 cases. According to different fusion segments, 11 cases（ group A）were performed with cervical occipital fusion, and 41 cases （ group B） were performed with atlantoaxial fusion, respectively. The clinical efficacy was evaluate by the combination of the JOA law and neck missing degrees in patients. There was no significant change in age, preoperative JOA score, preoperative cervical activity between two groups. Results All patients successfully completed the surgery, postoperative did not appear complications, which of all were obtained from 12 to 46 months of follow-up, with an average of 21.3 months. There was no significant difference with postoperative JOA score in the two groups of patients （ P 〉 0. 05 ）, but between the lateral flexion, rotation, flexion and extension loss rate there were significant differences （P 〈 0.05 ）. Compared with occipital fusion, there was a significantly decrease in neck mobility loss rate after atlantoaxial fusion. After review of X-ray, see interbody fusion without internal fixation loose or broken nails phenomenon. Conehtsions These two approaches had similar clinical outcomes to achieve a satisfactory bone graft fusion and neurological symptom relief. Compared to craniocervi fusion, atlantoaxial fusion had little influence on ROM and degeneration of cervical spine,which was the preferred surgical method for upper cervical spine affections. But some have occipitocerxical fusion case required masters strictly get used to disease, combined with the causes of the use of corresponding operation and fixation type.