16例上颈椎融合术的失败原因与翻修结果

Failure reasons and revision outcomes of 16-case upper cervical instrumented fusion

[目的]对上颈椎融合固定术后翻修的原因进行分析,评价翻修术后疗效。[方法]回顾性分析2017年—2021年本科收治的16例上颈椎融合失败翻修术的患者,分析翻修原因与翻修术的临床影像结果。[结果]翻修原因为,5例寰枢椎脱位未能完全复位;5例术后植骨不融合;3例减压不彻底;2例肿瘤患者均为术后肿瘤复发;1例手术后1周感染。所有患者均顺利完成翻修手术,术中均无神经、血管损伤等严重并发症,手术时间(216.25±23.34)min,术中出血量(406.25±103.08)ml,术后切口愈合良好。1例肿瘤患者失访,余15例患者随访时间平均(31.35±8.98)个月。随时间推移,JOA评分显著增加(P<005),ASIA评级显著改善(P<005)。影像方面,翻修术后颈头对线较术前显著改善(P<0.05),ADI较术前显著减小(P<0.05),SAC较术前显著增加(P<0.05)。[结论]上颈椎翻修因素很多情况下互相影响,互为因果。合理制定翻修手术方案和术中精准操作,翻修术仍可获得满意临床效果。

[Objective] To explore the reasons for revision of upper cervical instrumented fusion, and to evaluate the clinical efficacy of revision surgery. [Methods] A retrospective study was performed on 16 patients who underwent revision surgery for failed upper cervical fusion in our department from 2017 to 2021. The reasons for revision, as well as the clinical and imaging consequences of revision surgery were evaluated. [Results] The reason for revision surgery proved improper reduction of atlantoaxial dislocation in 5 cases, nonunion of bone graft in 5 cases, incomplete decompression in 3 cases, tumor recurrence in 2 cases and infection in 1 case. All the 16 patients had revision surgery performed smoothly, with operation time of(216.25±23.34) min, the intraoperative blood loss of(406.25±103.08) ml, and the good incision healing. Except one patient who suffered from tumor patient was lost to follow-up, all the patients were followed up for(31.35±8.98) months on a mean. The JOA scores increased significantly(P<005), and ASIA grade for neurological function improved significantly over time(P<005). Radiographically, the head-neck alignment was significantly improved(P<0.05), ADI decreased significantly(P<0.05), whereas SAC significantly increased after revision surgery compared with those preoperatively(P<0.05). [Conclusion] The factors related to revision of upper cervical fusion influence each other in many cases. Reasonable formulation of revision surgical plan and accurate operation do still achieve satisfactory clinical outcomes.