肖嵩华;毛克亚;王岩;张永刚;张雪松;王征;陆宁;崔庚;

• 1:解放军总医院骨科

摘要(Abstract)：

[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。

关键词(KeyWords)： 先天性畸形;上颈椎;诊断;治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 肖嵩华;毛克亚;王岩;张永刚;张雪松;王征;陆宁;崔庚;

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