先天性上颈椎畸形诊断及治疗分析.docVIP

先天性上颈椎畸形诊断及治疗分析 　作者：肖嵩华，毛克亚　王岩，张永刚，张雪松，王征，陆宁，崔庚 【摘要】 [目的]分析先天性上颈椎畸形造成上颈椎不稳的病因，探讨其手术方法的选择。[方法]2003年1月～2007年6月收治65例先天性上颈椎畸形，男39例，女26例，术前常规进行X线片、CT和MRI检查，根据影像学分为发育不全畸形32例，分节不全畸形18例，结构畸形15例。37例可以复位并且脊髓前方无明显受压患者采用后路固定、植骨融合，其他28例上颈椎脱位不可复位或者脊髓前方存在压迫患者，首先采用前方齿状突切除、减压，然后经后路内固定、取自体松质骨植骨融合。[结果]所有患者均顺利完成手术，未出现脊髓血管损伤等严重并发症。65例患者中47例获得随访，随访12～24个月，平均随访(15±6)个月。1例患者后路钛棒断裂，再次手术更换断裂钛棒，其余患者后方植骨形成骨性融合。34例上颈椎局部疼痛、活动受限患者中28例获得随访，患者疼痛均明显减轻或者消失。31例四肢麻木、上运动神经元损伤患者中19例患者获得随访，采用Frankel脊髓评分，术前患者评分5例B，8例C，17例D;获得随访患者术后Frankel评分5例C，6例D，8例E，与术前相比神经功能改善1～2级。[结论]根据先天性上颈椎畸形的病因、环枢椎复位和脊髓受压情况，分别选择后路或者前后路联合手术治疗。 【关键词】 先天性畸形; 上颈椎; 诊断; 治疗 　　Abstract: [Objective]To analysis the unstable pathogeny of the superior cervical congenital deformity for the operative method selection. [Methods]65 patients with congenital superior cervical deformity were treated from January 2003 to June 2007, in which there were 39 male patients, and 26 female patients. The X-ray, CT and MRI were examined generally before operation. In the images, there were 32 cases with formation failure deformity, 18 cases with segmentation failure deformity, and 15 cases with abnormal structure deformity. 37 cases with easy reduction and no anterior compression were treated with posterior internal fixation and self cancellous bone graft for fusion. The other 28 cases with impossible reduction and anterior spinal cord compression were treated with anterior odontoid resection and decompression, and then posterior internal fixation and self cancellous bone graft for fusion.[Results]All of the operations were sucesseful without never and vascular injury and other serious complication. There were 47 cases following up 12 to 24 months in the 65 cases, and the mean follow up 15 6 months.One case?s broken up titanium rod were treated with replacing new rod and bone graft, and the other cases showing bone fusion. There 28 cases following up in 34 cases with superior cervical pain and resticted movement, in which the pain was decreased or disappeared.