后路固定颈前路鼻内镜辅助病灶清除治疗上颈椎结核

Posterior cervical fixation combined with nasal endoscopic tuberculosis excision to treat upper cervical tuberculosis

目的探讨后路固定颈前路鼻内镜辅助病灶清除治疗上颈椎结核的疗效。方法上颈椎结核12例,均先行后路上颈椎侧块螺钉及颅骨钉棒系统固定及植骨,其中4例寰椎并枢椎结核行枕颈融合者植骨于枕颈部,8例枢椎结核仅在寰枢椎间植骨再行前路鼻内镜辅助结核灶清除。结果患者术后颈椎稳定性均得到满意重建,经术中镜下及术后影像学检查证实结核病灶全部清除。手术时间160～250(198±27)min;术中出血量300～500(388±61)ml。手术过程顺利,未发生脊髓、神经根、椎动脉等重要解剖结构的损伤,无脑脊液漏发生。术后JOA评分由术前的8～14(10±2)分提高至10～16(14±2)分。结论后路融合可使颈椎获得较好稳定性,前路鼻内镜下能彻底清除病灶,术后患者症状改善,此术式治疗上颈椎结核效果满意。

Objective To discuss the effect and prognosis in treatment of upper cervical tuberculosis by posterior stability reconstruction combined with tuberculosis excision under nasal endoscope.Methods 12 patients with upper cervical tuberculosis underwent upper cervical lateral mass and cranial screws and rods fixation,nasal endoscopic tuberculosis excision and bone graft. 4 of them suffered from atlantoaxial tuberculosis underwent occipito-cervial graft,the other 8 suffered from dental tuberculosis underwent atlantoaxial graft.Results The stability of the cervical spine was well reconstructed and the focuses of tuberculosis were cleaned up thoroughly in all the 12 patients. Operation time was 160～250（198±27）min. Intraoperative blood loss was 300500（388±61）ml .There was no side injury during the operation .The patients had significant increase in JOA Score from 8～14（10±2）preoperation to 10～16（14±2）postoperation.Conclusions The process of tuberculosis excision under nasal endoscope combined with posterior fixation can gain good reconstruction of the cervical and the patients condition can be obviously improved.It is a surgical option for treatment of upper cervical tuberculosis with good result.