枕颈融合术治疗枕颈失稳的临床疗效评价

Efficiency of the occipitocervical fusion for occipitocervical instability

目的：探讨枕颈融合术治疗枕颈失稳的临床疗效。方法：回顾性研究了2007年8月至2014年4月本院收治的47例患有枕颈失稳的患者,所有患者均接受枕颈融合手术治疗,其中男性34例,女性13例,年龄15～77岁,平均年龄（50.87±14.08）岁。术前诊断为创伤性寰枢椎骨折/脱位33例,先天性枕颈畸形12例,上颈椎肿瘤1例,类风湿关节炎1例。应用颈椎日本骨科协会评估治疗（Japanese orthopaedic association,JOA）评分、视觉模拟评分量表（visual analog symptom rating scale,VAS）评分及术前术后影像学资料评价手术疗效。结果：全部病例均得到随访,术后随访时间为8～88月,平均随访时间为（45.79±16.12）月,术后X线检查提示46例枕颈部植骨融合良好,1例植骨融合失败,植骨融合率97.9%;JOA评分由术前（12.32±2.97）分,降至术后（14.85±2.26）分;VAS评分由术前（6.55±1.14）分,降至术后（1.91±1.06）分;JOA及VAS评分术前术后差异具有统计学意义（t=-15.77,P=0.000;t=52.54,P=0.000）。结论：应用颈椎弓根螺钉和板-棒系统行枕颈融合术,因其优秀的力学稳定性及植骨融合率,是解决枕颈结合部失稳的安全、可靠方法。

Objective：To evaluate the treatment efficiency of occipitocervical fusion for occipitocervical instability. Methods：Totally47 patients of occipitocervical instability treated by occipitocervical fusion from August 2007 to April 2014 were reviewed. All the patients including 34 males and 13 females underwent occipitocervical fusion. The average age of included cases was（50.87±14.08）years（ranged from 15 to 77 years）. The pre-operative diagnoses was made on 33 cases of atlanto-axial fracture or dislocation by injury,12 cases of congenital occipitocervical anomalies,one case of upper cervical tumor and one case of rheumatoid arthritis.Japanese orthopaedic association（JOA）scale,visual analog symptom rating（VAS）scale,pre- and post-operative radiographic data were used for efficacy assessment. Results：All the cases were followed up for 8 to 88 months,averaged（45.79 ±16.12） months.Forty-six of the total cases showed bony fusion on the postoperative X-ray film. The fusion rate was 97.9%. Mean preoperative JOA score and VAS score were（12.32±2.97）points and（6.55±1.14）points while postoperative were（14.85±2.26）points and（1.91±1.06） points,respectively. There were significant differences between preoperative and postoperative results（t =-15.77,P =0.000;t =52.54,P=0.000）. Conclusion：Posterior occipitocervical fusion using the cervical pedicle screws and plate-rod systems is an effective surgical technique for occipitocervical instability and satisfactory fusion status could be achieved with perfect biomechanical stability.