枕颈融合与寰枢椎融合治疗上颈椎失稳症的疗效比较

目的探讨枕颈融合与寰枢椎融合治疗上颈椎失稳的疗效及对颈椎退变的影响。方法 2004年6月～2008年6月收治且获得2年以上随访的上颈椎失稳患者共33例,根据融合节段不同,分为A(枕颈融合)组和B(寰枢椎融合)组。按照JOA法评估神经功能,应用X线片评价两组患者植骨融合情况及颈椎退变情况;比较两组患者的临床疗效和颈椎活动度等方面的差异。两组病例年龄、术前JOA评分、术前颈椎活动度和术前牵引时间无统计学差异。结果 A、B两组均顺利完成手术,术中、术后未出现并发症。两组病例的植骨融合情况及术后JOA评分差异无统计学意义(P>0.05)。术后颈椎的屈伸活动度、颈椎曲度两组之间差异有统计学意义(P<0.05)。结论颈枕融合及寰枢椎融合均能取得满意的植骨融合和神经症状缓解,但相比枕颈融合,寰枢椎融合对颈椎的屈伸活动度、颈椎曲度影响较小,应为上颈椎失稳的首选手术方式。

Comparative study of craniocervi fusion vs.atlanto-axial fusion in treating subaxial cervical spine instability

Objective To investigate the clinical outcome and degeneration for the treatment of subaxial cervical spine instability with craniocervi fusion or atlanto-axial fusion.Methods From June 2004 to June 2008,33 patients with subaxial cervical spine instability treated with fusion and followed up for more than two years were reviewed retrospectively.All patients were divided into group A(craniocervi fusion) and B(atlanto-axial fusion) based on interbody fusion methods.JOA was used to evaluate the neurological symptoms,and the fusion status and degeneration of cervical spine were evaluated by X-ray.The clinical outcome and the range of motion(ROM) of cervical spine in the two groups were also compared.No significant difference was noted between two groups with respect to age,JOA,ROM of cervical spine and traction time preoperation.Results All operations were performed successfully.No surgery-related complications were noted after operation.The fusion status and JOA score showed no difference between two groups(P>0.05).There were significant differences between two groups regarding to ROM of cervical spine(P<0.05).Conclusion These two approaches had similar clinical outcomes to achieve a satisfactory bone graft fusion and neurological symptom relief.Compared to craniocervi fusion,atlanto-axial fusion had little influence on ROM and degeneration of cervical spine,which was the preferred surgical method for upper cervical spine instability.