经口咽病灶清除联合后路融合内固定治疗上颈椎结核

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

中文关键词:  上颈椎  经口咽  后路固定  结核

英文关键词:Upper cervical spine  Transoropharyngeal  Posterior fixation and fusion  Tuberculosis

中文摘要:

  【摘要】 目的：探讨经口咽病灶清除联合后路融合内固定术治疗上颈椎结核的临床疗效。方法：2003年1月～2013年12月，应用经口咽病灶清除联合后路融合内固定术治疗上颈椎结核患者19例，男12例，女7例，平均年龄41.9±8.3岁（6～71岁）。其中寰椎结核11例，寰枢椎结核6例，寰椎并寰枕关节结核2例，病灶均破坏累及寰枕关节或寰枢椎侧块，均伴有寰枢关节脱位，病灶周围脓肿形成。采用JOA评分评价脊髓神经功能，VAS评分评价枕颈部疼痛症状，寰齿间隙（ADI）评价复位情况，定时随访并复查X线片、CT评价植骨融合情况。结果：19例患者均成功接受手术，其中行枕颈融合11例，寰枢椎融合7例，C1～C3融合1例。术中未出现脊髓神经及血管损伤。所有患者均获得随访，平均随访33.2±7.2个月（24～48个月）。随访复查X线片、CT显示椎前脓肿消失、寰枢椎复位良好，未发生内固定松动、断裂等；17例术后3个月实现后路骨性融合或前路骨缺损部植骨骨性愈合，另2例术后6个月达骨性融合。术后病理检查均证实结核杆菌感染病灶，术后抗结核药物平均用药时间16.9±1.3个月。随访期间结核无复发，术后18个月结核病变均达到临床治愈。JOA评分由术前的7.9±1.1分上升到末次随访时的14.7±1.2分（P＜0.05）；枕颈部VAS评分由术前的6.5±0.4分下降到末次随访时的1.0±0.5分（P＜0.05），ADI由术前5.6±1.3mm 减小至术后1.6±0.9mm（P＜0.05），围手术期及术后随访未发现严重的并发症。结论：经口咽病灶清除联合后路融合内固定术是治疗上颈椎结核的一种安全有效的手术方法。

英文摘要:

  【Abstract】 Objectives: To investigate the effectiveness of anterior transoropharyngeal debridement combined with posterior fixation and fusion for upper cervical tuberculosis. Methods: From January 2003 to December 2013, 19 patients with upper cervical tuberculosis underwent the surgery of anterior transoropharyngeal debridement combined with posterior fixation and fusion in our hospital, there were 12 males and 7 females, with an average age of 41.9±8.3(6-71) years old. 11 cases had tuberculosis located in atlas with 6 atlantoaxial and 2 atlanto-occipital, all with atlanto-occipital joint or atlantoaxial lateral mass destructed severely, abscess was formed around lesion. JOA score, occipitocervical VAS score, ADI and fusion status were reviewed retrospectively. Results: 19 patients all accepted surgery successfully, 11 cases underwent occipitocervical fusion and fixation, 7 cases underwent atlantoaxial fusion and fixation and 1 case underwent C1-3 fusion and fixation. No spinal cord, nerve or blood vessel injury was noted during operation. All cases were followed up for an average of 33.2±7.2 months. Abscess was cleared completely and anatomical reduction was achieved in all cases according to X ray and CT scan. Bony fusion was achieved in 17 cases at 3 months later and the other 2 achieved bony fusion at 6 months later. Anti-TB drugs were used for an average of 16.9±1.3 months. All cases were clinical cured in 18 months after operation and no occurrence of nidus was found during follow-up. The JOA score increased from 7.9±1.1 preoperatively to 14.7±1.2 at final follow-up(P＜0.05), VAS of neck pain decreased from 6.5±0.4 preoperatively to 1.0±0.5 at final follow-up(P＜0.05), ADI decreased from 5.6±1.3mm preoperatively to 1.6±0.9mm at final follow-up(P＜0.05). No serious complications were noted during follow-up. Conclusions: Anterior transoropharyngeal debridement combined with posterior fixation and fusion is an effective treatment for upper cervical tuberculosis.