论文部分内容阅读
[目的]分析评价一期前后路联合手术治疗寰枢椎结核合并神经功能损害的临床疗效.[方法] 2005年1月～2015年1月,12例寰枢椎结核合并神经功能损害患者采用一期前后路手术治疗.所有患者术前颈椎CT及MRI检查提示寰椎单侧或双侧侧块骨质破坏及枢椎齿突不同程度骨质破坏,寰枢椎稳定性丢失,结核病灶突入椎管内,导致相应节段脊髓受压.术前神经功能评估ASIA分级为:C级4例,D级8例.所有患者术前及术后均使用四联敏感抗结核药物规律治疗.通过对患者NDI评分和JOA评分变化情况进行统计学分析来评价临床手术疗效.[结果]手术时间平均(228±65.32) min;出血量平均(460±116.38) ml.平均随访(5.77±3.62) (2～12)年,在随访期内未见内固定松动、断裂、失败等情况出现.患者NDI评分及JOA评分分别由术前(39.67±4.32)分和(7.63±2.38)分改善至末次随访时(10.82±4.63)分和(15.58±1.21)分,差异有统计学意义(P＜0.05).末次随访时12例患者神经功能ASIA分级均恢复至E级.[结论]对于寰枢椎结核合并神经功能损害的治疗,采用一期前后路联合手术能够完成结核病灶的彻底清除、脊髓的彻底减压及上颈椎稳定性的重建,通过中长期随访观察能够取得良好的临床疗效.“,”[Objective] To evaluate the clinical outcomes of one-stage combined anterior and posterior surgery for treatment of aflantoaxial tuberculosis with neurological impairment.[Methods] From January 2005 to January 2015,12 patients who suffered from atlantoaxial tuberculosis with neurological impairment were surgically treated by one-stage combined anterior and posterior procedure.All patients had tuberculosis lesion involved unilateral or bilateral lateral mass of the atlas and the odontoid process,accompanied with atlantoaxial instability,and corresponding spinal cord compression revealed by preoperative CT scanning and MRI.In term of preoperative neurological function,4 patients were categorized as Grade C and 8 patients as Grade D according to the American Spinal Injury Association (ASIA) system.All the 12 patients received the regular quadruple therapy of sensitive anti-tuberculosis drugs pre and postoperatively.The Neck Disability Index (NDI) and Japanese Orthopedic Association (JOA) scoring system were used for evaluation of the clinical outcome.[Results] The surgical operation lasted for (228±65.32) min,with intraoperative blood loss of (460±116.38) ml on average.All the patients were followed up for an average of (5.77±3.62) years ranged from 2 to 12 years.No instrumentation loosening,migration or breakage was noted in any patient during the follow-up.The NDI significantly decreased from (39.67±4.32) preoperatively to (10.82±4.63) at the latest follow up (P＜0.05),conversely,JOA scores statistically increased from (7.63±2.38) to (15.58± 1.21) (P＜0.05).At the latest follow up,all the 12 patients got complete recovery in neurological function,associated with ASIA improvement to Grade E.[Conclusion] For treatment of atlantoaxial tuberculosis with neurological impairment,one-stage combined anterior and posterior surgical procedure does achieve satisfactory medium and long term clinical outcomes because complete debridement,decompression,and reconstruction of the upper cervical stability can be available by this procedure.