改良枕颈融合术在上颈椎翻修手术中的应用

Modified occipitocervical fusion in upper cervical revision

目的:探讨改良枕颈融合手术在上颈椎翻修手术中的应用。方法:2002年6月至2006年1月采用自行设计的枕骨板障螺钉联合颈椎椎弓根螺钉枕颈固定系统治疗11例上颈椎手术后因上颈椎不稳、残留颈髓压迫或肿瘤复发需再次手术的患者,其中9例患者获得随访,原发疾病包括先天性枕颈融合畸形3例,上颈椎肿瘤2例,上颈椎结核2例,颅底凹陷2例。术前和术后神经功能评价采用Frankel分级标准,根据术后当时以及随访时的X线片评价融合情况。结果:术中无神经、血管损伤。随访7～28个月,平均25个月,9例患者均获得了骨性融合,无断钉以及内固定失败等并发症。结论:枕骨板障螺钉联合颈椎椎弓根螺钉组成的枕颈固定器具有坚强的固定作用,是对常规枕颈融合手术的一种补充,适用于上颈段病变因第1次手术后导致上颈椎不稳、残留颈髓压迫需再次手术者,尤其适用于枕骨缺损、颅底骨质薄和骨质疏松的患者。

Objective：To explore the clinical outcome of modified occipitocervical fusion in patients with upper cervical disorders necessitating revision.Method：A total of 11 patients with upper cervical revision from June 2002 to January 2006,were reviewed retrospectively.All cases underwent the surgical protocol of combining screws via diploe parallelly with pedicle screws instruments.Of 9 cases followed up,there were 3 cases of congenital occipitocervicaldosis,2 cases of recurrent cervical tumor,2 cases of upper cervical tuberculosis,2 cases of Chiari Ⅰ type malformation,prior to the revision,they all underwent the first operation due to the original disease.The Frankel system was used to evaluate the neurological status of each patient, and the radiological files were collected to demonstrate the fusion status.Result：9 cases were followed up for an average of 25 months,bony fusion was seen in 9 patients,and no neurovascular injury or instrument failure were documented.Conclusion：This modified instrument combined with cervical pedicle screws can ensure the solid craniocervical stability,which can be viewed as an alternative to the commonly used instruments.This protocol can be applied in patients necessitating reoperation while the conventional surgery is not available.