后路病灶清除短节段融合治疗上颈椎骨质破坏性疾病

Posterior Focus Clearance and Short-segment Fusion to Treat Destructive Diseases of Upper Cervical Vertebra

目的探讨后路病灶清除、短节段植骨融合治疗上颈椎骨质破坏性疾病的临床疗效及价值。方法回顾性分析2005年6月～2009年4月,笔者医院收治的上颈椎骨质破坏性疾病56例,其中适合进行短节段融合的15例,行后路手术进行病灶清除、短节段内固定、植骨融合治疗后,根据术前、术后及随访时疼痛的VAS评分、神经功能的JOA评分、植骨后骨质融合率等,以统计学方法分析和评价临床疗效。结果 15例获得6个月～3年的随访,无一例出现术后并发症,神经功能障碍均有不同程度恢复,所有患者6个月内植骨区骨性融合。术后疼痛VAS评分均较术前明显改善(P<0.001);神经功能障碍JOA评分,术后较术前明显改善(P<0.05)。结论对上颈椎骨质破坏性疾病行后路病灶清除、短节段固定、植骨融合方法治疗,具有良好的临床疗效及应用价值。

Objective To investigate the clinical effects and value of the posterior focus clearance and short-segment fusion to treat destructive diseases of upper cervical vertebra.Methods Fifty-six patients with upper cervical bone destructivity admitted into our hospital between June 2005 and April 2009 were studied retrospectively. Fifteen cases were treated by posterior focus clearance, short-segment in- ternal fixation and bone graft fusion. Then evaluating the clinical efficacy with statistical analysis based on the materials about the VAS scores of pain, JOA scores of nerve function and rate of bone graft fusion etc, which were collected at certain time （before operating, a week after operating ,3 months after operating and the latest follow-up ） .Results All the 15 cases were followed for 6 to 36 months, 18 months in average. In the 15 cases, no postoperative complications were found, and neurologic function was improved in various degrees. All patients got bony fusion within 6 months. The postoperative VAS scores are lower than preoperative, and the difference was statistically sig- niticant（P 〈0.001 ）.The postoperative JOA scores of nerve function had been superior to preoperative scores（P 〈0.05）.Conclusion It is a effective and valuable method to use one-stage debridement, short-segment internal fixation and bone grafting from posterior approach to treat destructive lesions of upper cervical vertebra.