经口咽病灶清除联合后路融合内固定治疗上颈椎结核

发布时间：2018-05-10 16:33

本文选题：上颈椎 + 经口咽　；参考：《中国脊柱脊髓杂志》2017年05期

【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(P0.05);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(P0.05),ADI由术前5.6±1.3mm减小至术后1.6±0.9mm(P0.05),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。
[Abstract]:Objective: to evaluate the clinical effect of transoropharyngeal debridement combined with posterior fusion and internal fixation in the treatment of upper cervical tuberculosis. Methods: from January 2003 to December 2013, 19 patients (12 males and 7 females) with upper cervical tuberculosis were treated with transoropharyngeal debridement combined with posterior fusion and internal fixation, with an average age of 41.9 卤8.3 years. There were 11 cases of atlantooccipital tuberculosis, 6 cases of atlantoaxial tuberculosis, 2 cases of atlantooccipital joint tuberculosis and atlantooccipital joint tuberculosis. All the lesions destroyed the atlantooccipital joint or lateral mass of atlantoaxial joint, accompanied by atlantoaxial dislocation, and the surrounding abscess was formed. The JOA score was used to evaluate the symptoms of occipitocervical pain, the atlantoodontoid space (ADI) was used to evaluate the reduction, and the bone graft fusion was evaluated by regular follow-up and X-ray CT. Results all the 19 cases underwent successful operation, of which 11 cases underwent occipitocervical fusion and 7 cases underwent C _ 1C _ 3 fusion of atlantoaxial fusion. There was no injury of spinal cord nerve and blood vessel during operation. All patients were followed up (mean 33.2 卤7.2 months, 24 ~ 48 months). Follow-up examination showed that prevertebral abscess disappeared, atlantoaxial reduction was good, no loosening of internal fixation, fracture and other 17 cases achieved posterior osseous fusion or anterior bone graft healing 3 months after operation. The other 2 cases had bone fusion 6 months after operation. The postoperative pathological examination confirmed the tuberculous bacilli infection lesion, the average time of antituberculous drugs after operation was 16.9 卤1.3 months. There was no recurrence of tuberculosis during follow-up. In 18 months after operation, the clinical cure rate of tuberculosis was increased from 7.9 卤1.1 to 14.7 卤1.2 and the VAS score of occipital neck decreased from 6.5 卤0.4 to 1.0 卤0.5, respectively, from 5.6 卤1.1 to 5.6 卤1.3mm. 1. 6 卤0. 9mm, P 0. 05, no serious complications were found in perioperative period and postoperative follow-up. Conclusion: transoropharyngeal debridement combined with posterior fusion and internal fixation is a safe and effective method for the treatment of upper cervical tuberculosis.
【作者单位】：广州军区广州总医院脊柱外科;广州中医药大学研究生院;
【分类号】：R687.3

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