颈前咽后入路病灶清除联合后路寰枢椎融合治疗寰枢椎结核的疗效观察

Anterior retropharyngeal debridement combined with posterior atlantoaxial fusion for atlantoaxial Tuberculosis

目的评估颈前咽后入路病灶清除联合后路寰枢椎融合治疗寰枢椎结核的疗效。方法回顾分析2005年2月至2013年2月郑州大学人民医院骨科接受颈前咽后入路病灶清除联合后路寰枢椎融合治疗的寰枢椎结核患者7例的临床资料；男3例，女4例。术前和末次随访时采用日本骨科学会颈椎功能评分（JOA）、颈椎残障指数（NDI）和Frankel分级进行神经功能评价并计算末次随访JOA评分改善率。末次随访时，采用Odom’s分级评估临床疗效；术前及末次随访通过影像学检查评估内固定及植骨融合情况。结果术后12个月7例均获骨性融合，17—21个月结核病变均达到临床治愈；末次随访时，JOA评分由术前的（11．1±0．7）分上升到（15．3±0．5）分（P〈0．05）；NDI评分由术前的（34．0±4．6）分下降到（10．1±1．3）分（P〈0．05）。末次随访，按Odom’s标准评价，优5例，良1例，可1例，Frankel分级均由D级上升至E级。结论对于寰枢椎的临床治疗，颈前咽后入路病灶清除联合后路寰枢椎融合，配合局部抗结核药物应用，临床疗效确切，病灶清除彻底，是治疗寰枢椎结核的一种可靠方式。

Objective To evaluate the clinical efficacy of anterior debridement combined with posterior adantoaxial fusion for atlantoaxial Tuberculosis. Methods From February 2005 to February 2013, 7 patients,3 males and 4 females, with atlantoaxial Tuberculosis underwent anterior debridement combined with posterior atlantoaxial fusion in Department of Orthopedics Zhengzhou University People＇s Hospital were selected. In the preoperative and final follow-up, Japanese Orthopaedic Association score （ JOA ）, neck disability index （NDI） and Frankel Classification were used to evaluate neurological function and calculate improvement rate. At final follow-up, clinical efficacy was evaluated by Odom＇s grade. Situation of internal fixation, fusion of upper cervical were assessed by X-ray, CT scan and MRI scan. Results Bony fusion were achieved in 7 cases after operation in 12 months. Tuberculosis were reached clinical cure between 17 and 21 months. At follow The JOA score increased from （11.1 ± 0. 7 ） preoperatively to （15.3 ±0. 5 ） in final follow-up（ P 〈 0.05 ）, and the NDI decreased from （ 34.0 ± 4. 6 ） preoperatively to （ 10. 1 ± 1.3 ） in final follow-up （ P 〈 0. 05 ）. At last follow-up, according to Odom＇s standard, excellent were obtained in 5 cases, good 1 cases and ordinary 1 case. Frankel Classification of all cases improved from D class to E. Conclusions The treatment of anterior retropharyngeal debridement combine with atlantoaxial fusion, and local anti-tuberculosis drug using intraoperative, not only could obtain reliable clinical efficacy, eompletly removal of lesions, but also obtain strong stability, which plays an important role in the treatment of atlantoaxial Tuberculosis.