先天性上颈椎畸形的诊断与治疗分析

《先天性上颈椎畸形的诊断与治疗分析》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。

1、先天性上颈椎畸形的诊断与治疗分析作者：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

2、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

3、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。12【关键词】先天性畸形;上颈椎;诊断;治疗　　Abstract:[Objective]Toanalysistheunstablepathogenyofthesuperiorcervicalcongenitaldeformityfortheoperativemethodselection.[Methods]65patientswithcongenitalsuperiorcervicaldeformityweretreatedfromJanuary2003toJun

4、e2007,inwhichtherewere39malepatients,and26femalepatients.TheX-ray,CTandMRIwereexaminedgenerallybeforeoperation.Intheimages,therewere32caseswithformationfailuredeformity,18caseswithsegmentationfailuredeformity,and15caseswithabnormalstructuredeformity.37caseswitheasyreduct

5、ionandnoanteriorcompressionweretreatedwithposteriorinternalfixationandselfcancellousbonegraftforfusion.Theother28caseswithimpossiblereductionandanteriorspinalcordcompressionweretreatedwithanteriorodontoidresectionanddecompression,andthenposteriorinternalfixationandselfca

6、ncellousbonegraftforfusion.[Results]Alloftheoperationsweresucessefulwithoutneverandvascularinjuryandotherseriouscomplication.Therewere47casesfollowingup12to24monthsinthe65cases,andthemeanfollowup156months.Onecase’sbrokenuptitaniumrodweretreatedwithreplacingnewrodandboneg

7、raft,andthe12othercasesshowingbonefusion.There28casesfollowingupin34caseswithsuperiorcervicalpainandrestictedmovement,inwhichthepainwasdecreasedordisappeared.Therewere19casesfollowingupin31caseswithnumblimbsandsuperiornevercenterinjury.ThepreoperativeFrankelscoreshowed5c

8、asesB,8casesC,and17casesD.ThepostoperativeFrankelscoreoffollowingupcasesshowd5casedC,6casesD,and8casesE