颈前咽后入路病灶清除联合后路枕颈融合固定术治疗上颈椎结核

Anterior retropharyngeal debridement combined with posterior fixation and fusion for upper cervical tuberculosis

中文关键词:  上颈椎  寰枢椎  枕颈融合  结核

英文关键词:Upper cervical spine  Atlantoaxial  Occipital-cervical fusion  Tuberculosis

中文摘要:

  【摘要】 目的：探讨颈前咽后入路病灶清除联合后路枕颈融合固定术治疗上颈椎结核的临床效果。方法：2002年1月～2012年6月在我院接受手术治疗的上颈椎结核患者共21例，均伴有寰枢关节、寰枕关节严重破坏且寰椎侧块破坏无法置钉的11例，男7例，女4例，年龄40.4±9.5岁（26～54岁），寰椎结核4例，寰椎并枢椎结核7例，均行颈前咽后路病灶清除并一期后路枕颈融合内固定术。根据枢椎椎弓根破坏情况，2例采用双侧枢椎椎弓根螺钉固定，3例采用双侧椎板螺钉固定，6例采用一侧椎板螺钉和一侧椎弓根螺钉混合固定。术后应用抗结核药物治疗18个月，并随访其神经功能（JOA评分）、枕颈部VAS评分、植骨融合情况、复位程度及并发症。结果：11例患者平均随访39.5±13.1个月。术后9例获解剖复位，2例达部分复位；术后4个月10例达到骨性融合，1例出现部分植骨吸收，经对症治疗，于术后6个月获骨性融合。术后18个月结核病变均达到临床治愈。JOA评分由术前的8.4±1.3分上升到末次随访时的15.0±1.3分（P＜0.05），枕颈部疼痛症状也由术前的6.7±0.6分下降到末次随访时的0.64±0.6分（P＜0.05），围手术期及术后随访未发现严重的并发症。结论：采用经咽后入路病灶清除联合后路固定融合术治疗上颈椎结核临床疗效可靠，病灶清除彻底，内固定牢靠，是一种安全有效的治疗方法。

英文摘要:

  【Abstract】 Objectives: To investigate the effectiveness of anterior retropharyngeal debridement combined with posterior occipitocervical fusion and fixation for upper cervical spinal tuberculosis. Methods: From January 2002 to June 2012, 21 patients with upper cervical tuberculosis underwent surgery in our hospital, 11 cases with atlantooccipital, lateral mass and atlantoaxial joint destructed severely were selected in this study. 7 of 11 cases were males, and 4 were females, the average age was 40.4±9.5 years(range, 26 to 54 years). 4 cases had tuberculosis in atlas and 7 in atlantoaxial. All cases underwent anterior retropharyngeal debridement combined with posterior fixation and fusion. According to the degree of pedicle destruction, bilateral pedicle screw fixation was performed in 2 cases, bilateral laminar screw in 3 cases and l hybrid fixation in 6 cases. Postoperative anti-TB drugs were used for 18 months, and JOA score, occipitocervical VAS score, fusion status, reduction degree and complications were reviewed retrospectively. Results: 11 patients were followed up for 39.5±13.1 months. Anatomical reduction was achieved in 9 cases, partially reduction in 2 cases, bony fusion was achieved in 10 cases 4 months later, and the other one achieved bony fusion at 6 months due to partially absorption of graft. All cases were clinical cured in 18 months after operation. The JOA score increased from 8.4±1.3 preoperatively to 15.0±1.3 at final follow-up(P＜0.05), VAS of neck pain decreased from 6.7±0.6 preoperatively to 0.6±0.6 at final follow-up(P＜0.05). No serious complications were noted during follow-up. Conclusions: The anterior retropharyngeal debridement combined with posterior fusion is an effective treatment for upper cervical tuberculosis.