一期前路病灶清除联合后路枕颈融合术治疗伴寰枕关节失稳的寰枢椎结核  

One-staged anterior radical debridement and posterior occipital-cervical fusion treatment for the atlanto-axial tuberculosis with the atlantooccipital joint destabilizing

作　　者：薛静波[1] 晏怡果[1] 王文军[1] 王程[1] 胡文凯[1] 欧阳智华[1] 李学林[1] 

机构地区：[1]南华大学附属第一医院脊柱外科,湖南衡阳421001

出　　处：《骨科》2017年第4期258-261,272,共5页ORTHOPAEDICS

摘　　要：目的探讨一期前路病灶清除联合后路枕颈融合术治疗伴有寰枕关节失稳的寰枢椎结核的临床疗效。方法 2011年2月至2015年10月采用一期前路病灶清除联合后路枕颈融合术治疗8例伴有寰枕关节失稳的寰枢椎结核病人。其中,男3例,女5例,年龄为29~56岁,平均为39.5岁。所有病人CT检查显示均伴有寰枕关节的骨质破坏,3例伴有寰枢椎脱位。其中4例病人有神经功能障碍,Frankel分级:C级2例、D级2例。C1椎体结核4例,C1~2椎体结核4例。椎前脓肿6例。8例病人术前影像学诊断为寰枢椎结核。病人术中均使用自体髂骨植骨。观察手术时间、出血量、术中术后并发症发生情况、随访植骨融合情况,神经功能恢复情况,比较术前及术后1周的疼痛视觉模拟量表(visual analogue scale,VAS)评分及日本骨科协会(Japanese Orthopaedic Association,JOA)颈椎神经功能评分。结果 8例病人均顺利完成手术,手术时间为180~290 min,平均为230 min;术中出血量为500~1 700 ml,平均为800 ml;术中病理检查确诊为结核。8例病人均获随访,随访时间为16~68个月,平均为24个月。1例术后出现吞咽困难及喝水呛咳,予以留置胃管1周后症状减轻,2周后症状消失。8例病人伤口均一期愈合,未出现伤口深部感染或窦道形成。病人均植骨融合。术前神经功能障碍者Frankel分级均恢复至E级。术后1周时VAS评分由术前的(8.62±1.51)分下降至(0.54±0.11)分,JOA评分由术前的(7.62±1.51)分上升至(16.33±1.68)分,差异均有统计学意义(均P<0.05)。随访期间无结核复发及内固定失败病例。结论一期前路病灶清除联合后路枕颈融合术治疗伴有寰枕关节失稳的寰枢椎结核能彻底地清除病灶,重建寰枕关节的稳定性,促进植骨融合,防止结核的复发。Objective To approach the clinical therapeutic effect of one-staged anterior radicaldebridement and posterior occipital-cervical fusion treatment for the atlantoaxial tuberculosis with theatlantooccipital joint destabilizing. Methods From February 2011 to October 2015, one-staged anteriorradical debridement and posterior occipital-cervical fusion treatment was carried out to cure 8 cases ifatlantoaxial tuberculosis with the atlantooccipital joint destabilizing. There were 3 male patients and 5 femalepatients. CT images for all these patients showed that they all had bone destruction of atlantooccipital joint, and3 cases had the atlantoaxial dislocation. Four 4 patients had the neurological dysfunction, two of them in theFrankel C class, and the rest in the Frankel D class. There were 4 cases of C_1 vertebral tuberculosis, 4 cases ofC_(1/2)vertebral tuberculosis, and 6 cases of prevertebral abscess. All these 8 patients received autologous iliaccrest graft in the operation. The intraoperative pathologic examination showed that all 8 cases had tuberculosisas their preoperative imaging diagnosis showed they had atlantoaxial tuberculosis. In this study, we observed theoperation time, hemorrhage volume, complication and follow-up treatment effect. Results All surgicalprocedures of these 8 patients were successfully completed. The operation time was 180-290 min(mean 230min). The intraoperative hemorrhage volume was 500-1 700 ml(mean 800 ml). All 8 patients were followed upfor 16-68 months(mean 24 months). Acataposis and drinking bucking occurred in one case, and his(her)symptom was alleviated one week after indwelling gastric tube. Two weeks later, his(her) symptom disappeared.All 8 patients wound obtained primary healing without deep infection or sinus formation. All grafted bone wasfused. And patients with neurological dysfunction all rehabilitated to the Frankel E class. VAS of neck paindecreased from 8.62±1.51 preoperatively to 0.54±0.11 at 1st week postoperatively, and the JOA score increasedfrom 7.62±1.51 preo

关 键 词：前路 病灶清除 枕颈融合 寰枢椎 结核 

分 类 号：R687.3[医药卫生—骨科学]