颈后路手术治疗类风湿性寰枢椎不稳

Posterior surgical approach for operation of atlantoaxial instability due to rheumatoid arthritis

目的 :对类风湿性寰枢椎不稳患者颈后路植骨融合、内固定手术进行探讨。方法 :对 2 1例类风湿性寰枢椎不稳患者采用颈后路植骨融合、内固定手术 ,其中 7例可复性寰枢椎半脱位行寰枢椎间植骨钛缆或Apofix固定术 ;14例难以复位者行枕颈间植骨Cervifix固定术。结果 :随访 6～ 2 8个月 (平均18个月 ) ,2 1例均无并发症发生 ,X线显示均获骨性融合 ,19例患者神经功能获不同程度改善 ,2例虽无改善但无神经损害发展。结论 :颈后路植骨融合、内固定术可为类风湿性寰枢椎不稳的患者提供牢固的融合固定 ,且以早期手术为佳。

Objective:To investigate the results of surgical treatment of atlantoaxial instability in rheumatoid arthritis through posterior approach.Methods:Twenty one patients with atlantoaxial instability due to rheumatoid arthritis were treated with posterior approach fusion and fixation. 7 patients were treated with atlantoaxial fusion with titanium wiring or Apofix fixation instrument,when the atlantoaxial subluxation could be reduced.The occipito cervical fusion was used in other 14 patients for the unduced atlantoaxial subluxation,if necessary combined with laminectomy of the atlas or decompression of the foramen magnum.Bone graft were needed in all patients.Results:With a mean follow up period of 18 months(6 to 28 months),satisfying stabilization of the atlantoaxial joint was achieved in all 21 patients without any complication.X ray films demonstrated complete osseous union.Neurological recovery was observed in 19 patients,except 2 patients remained minor neurologic deficit.Conclusion:Posterior fusion and fixation is recommended for atlantoaxial instability due to rheumatoid arthritis.Patients treated early in the course of the disease would have the most satisfactory effectiveness.