后路病灶清除联合寰枢椎融合治疗上颈椎结核

Posterior debridement combined with atlantoaxial fusion to upper cervical tuberculosis

目的 探讨后路病灶清除联合寰枢椎融合治疗上颈椎结核的临床效果.方法 对2007年3月至2012年4月施行后路病灶清除联合寰枢椎融合治疗的8例上颈椎结核患者的临床资料进行回顾分析.8例患者中,男性3例,女性5例,年龄29 ～ 65岁,平均（43.5±13.2）岁.根据寰枢椎骨质破坏情况,采用不同的枢椎固定方式（椎弓根螺钉或椎板螺钉）.术前和末次随访时使用日本骨科学会脊髓功能评分（JOA）、颈椎残障指数（NDI）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.随访过程中通过影像学检查评估植骨融合情况,并记录并发症的发生情况及其原因分析.结果 术后12个月8例患者均获骨性融合,12 ～ 18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（10.5±2.0）分提高至（15.6±1.1）分（P＜0.05）;NDI由术前的（29.9±6.2）分降至（8.6±1.6）分（P＜0.05）.末次随访时,按Odom＇s标准评价,优6例（75.0％）,良1例（12.5％）,可1例（12.5％）.结论 后路病灶清除联合寰枢椎融合术,配合恰当的植骨方案及局部应用抗结核药物,创伤小,临床疗效确切,而且可获良好的稳定性,是治疗上颈椎结核的一种可靠方式.

Objective To explore clinical results of posterior debridement combined with atlantoaxial fusion for upper cervical Tuberculosis.Methods From March 2007 to April 2012,8 patients with upper cervical Tuberculosis underwent posterior debridement combined with atlantoaxial fusion in our hospital were selected for retrospective analysis.3 cases were males and 5 females,aged 29-65 （43.5 ±13.2） years.According to the pedicle destruction,using different screws （pedicle screw or laminar screw）fixation.In the preoperative and final follow-up,Japanese Orthopaedic Association score （JOA） and neck disability index （NDI） were used to evaluate neurological function and calculate improvement rate JOA score.At final follow-up,clinical efficacy was evaluated by Odom＇s grade.situation of internal fixation,fusion of upper cervical were assessed by imaging examination.During follow-up,complications were documented and analyzed.Results Postoperatively 12 months,all bony fusion were achieved.Tuberculosis were reached clinical cure in 12-18 months.The JOA score increased from 10.5 ± 2.0 preoperatively to 15.6 ± 1.1 in final follow-up（P 〈0.05）,and the NDI decreased from 29.9 ± 6.2 preoperatively to 8.6 ±1.6 （P 〈 0.05）.At last follow-up,according to Odom＇s standard,excellent were obtained in 6 cases（75.0%）,good 1 cases （12.5%） and ordinary 1 case （12.5%）.No severe complications was documented during follow-up.Conclusions The treatment of posterior debridement combine with atlantoaxial fusion,and structure grafting and local anti-Tuberculosis drug using intraoperative,not only could obtain reliable clinical efficacy,completely removal of lesions,but also obtain strong stability,which plays an important role in the treatment of cervical tuberculosis.