颈后路融合术治疗寰枢椎不稳

Posterior cervical fusion for atlantoaxial instability

目的 :探讨枕颈和寰枢后路融合术治疗寰枢椎不稳的临床疗效。方法 :对 2 9例寰枢椎不稳患者行颈后路内固定自体髂骨植骨融合术 ,其中 1 4例行枕颈融合术 ,另 1 5例行寰枢椎融合术。结果 :术后寰枢椎脱位完全复位 1 9例 ,大部分复位 7例 ,未复位 3例。经 1～ 1 0年 (平均 6 .7年 )随访 ,除 1例术后 6个月死亡外 ,其余 2 8例均获骨性融合 ,其中钢丝断裂而植骨已融合 2例 ,枕颈融合后 4年枕部骨板断裂 1例 ,寰椎后弓钢丝切割断裂 1例 ,螺钉断裂 1例 ;所有患者颈痛全部消失 ;1 5例有脊髓病症状者中 ,3例无改善 (术前JOA评分分别为 4、5、5分 ) ,其余 1 2例JOA评分均较术前提高 ,分别为 1 3～ 1 7分。结论 :对术前脱位能纠正者宜行寰枢椎融合术 ,术前脱位复位不佳者宜行枕颈融合术 。

Objective:To evaluate the clinical effects of posterior cervical fusion in treating atlantoaxial instability.Methods:Of 29 evaluated patients with C 1～2 instability using autologous bone grafts and posterior internal fixation,14 were treated with cervical occipital fusion,other 15 were treated with C 1～2 fusion.Results:After operation,atlantoaxial dislocation was reduced completely in 19 patients,was reduced largely in 7 patients and was not reduced in 3 patients. The patients were followed postoperatively for 1～10 years(average=6.7 years). Twenty eight patients had ossious unions except one who died 6 months after operation. Neck pain disappeared completely in all patients,and 6 had showed significant improvement. Of 15 patients with neural deficit,12 had improvement(JOA score:13～17) and 3 failed to improve.Conclusion:For those the dislocation had been rectified,posterior C 1～2 fusion ought to be adopted,otherwise cervical occipital fusion ought to be used.