枕颈后路减压和固定治疗上颈段不稳的临床观察和分析

目的观察手术对原有的枕颈畸形或上颈段病变因急性损伤失稳定后的治疗效果，并分析手术成败的原因。方法6例原有枕颈畸形和上颈段病变的患者，因急性损伤造成上颈段失稳定和颈髓损伤；根据枕颈结合部畸形特点、上颈段脊髓受压和骨折情况，采用枕颈后路手术，对枕骨大孔后缘和（或）上颈椎行后路减压、枕颈后路内固定和内固定侧旁植骨。结果随访1～3年，术前手术设计合理的5例患者被治愈，不合理的1例患者死亡。死亡的主要原因是术前对颈髓受压情况估计不足，以致减压不彻底，内固定不当反而加重压迫。结论术前充分了解及分析病情和颈髓受压情况，并作出准确的手术设计，是避免手术失败的关键。

Clinical observation and analysis of posterior occipito-cervical decompression and fixation for the treatment of the instability of the upper cervical spine

Objective To observe the therapeutic effect of the posterior occipito-cervical decompression and fixation for the treatment of the instability of the upper cervical spine, and to analyze the causes of the outcomes. Methods Six patients of the instability of the upper cervical spine due to an acute injury with originally occipito-cervical deformity or disorder in upper cervical spine, were treated with in decompression different degree, internal fixation and local bone graft through posterior approach. Results After 1-3 years of follow-up,5 cases with a reasonable operative design before operation were bealed,and 1 case died because of a poor operative design and the misunderstanding of disorder conditions which led to incomplete decompression. Conclusion In order to avoid fault in operation, the key is to fully make clear of different conditions of deformity and disorder, carefully analyze compression situation, and make a reasonable operative design before operation.