上颈椎疾病手术方法选择

Selection of operative methods for upper cervical disease

目的分析上颈椎疾病的病因、寰枢椎复位和脊髓受压情况,探讨上颈椎疾病的手术方法选择。方法 2003-01至2007-06收治169例上颈椎疾病,根据病因分为:上颈椎骨折74例,先天性上颈椎疾病65例,肿瘤21例,其他病因导致寰枢椎不稳9例。根据病因、寰枢椎复位情况和脊髓受压情况分别采用前路手术、后路手术或者前后路手术。结果 28例可复位齿状突骨折患者采用前路空心螺钉内固定。97例上颈椎可复位,脊髓前方无明显受压患者采用单纯后路复位内固定,取自体松质骨植骨融合。44例难复位或脊髓前方明显受压患者采用前路减压、复位,后路内固定、取自体松质骨植骨融合。结论根据上颈椎疾病病因、复位和脊髓受压情况,应分别选择前路、后路或者前后路联合手术治疗。

Objective To study the upper cervical pathogenesis, atlantoaxial reduction and spinal cord compression for the operative method selection. Methods 169 patients with upper cervical disease were treated from January 2003 to June 2007, in whom there were 74 fracture cases, 65 congenital cases, 21 tumor cases, and 9 atlantoaxial unstable cases by other diseases. The anterior, posterior, or anterior - posterior approach was selected according to the pathogenesis, atlantoaxial reduction and spinal cord compression. Results 28 cases of feasible reduction odontoid fractures were treated by anterior internal fixation using cannulated screws. 97 cases of atlantoaxial redaction and without spinal cord anterior compression were treated by posterior internal fixation and self cancellous bone graft for fusion. 44 cases of impossible reduction or spinal cord compression were treated with anterior approach decompression, reduction firstly, and then posterior internal fixation and self cancellous bone graft for fusion. Conclusions The operative method of anterior, posterior, or anterior - posterior approach operation was selected according to the upper cervical pathogenesis, reduction and spinal cord compression.