Grob D, Dvorak J, Gschwend N, Froehlich M
Department of Orthopaedic Surgery, Wilhelm Schulthess Hospital, Zürich, Switzerland.
Arch Orthop Trauma Surg. 1990;110(1):38-44. doi: 10.1007/BF00431364.
The instability of atlanto-axial subluxation remains a challenging problem in patients with rheumatoid arthritis. In order to preserve as much function of the cervical spine as possible, inclusion of the occiput into the fusion should exclusively be performed when there is a radiologically or clinically manifest pathological condition of the atlanto-occipital joint or marked upward migration of the dens axis. In order to prevent irreversible damage to the spinal cord, an early indication of surgical stabilization is recommended. This article presents a retrospective analysis of the clinical and radiological results of occipito-cervical fusion in 26 patients with rheumatoid arthritis using a modified Brattström technique. The complications encountered were mainly due to the use of wire fixation, reinforcement using bone cement and insufficient reduction of atlanto-axial subluxation.
寰枢椎半脱位的不稳定性在类风湿性关节炎患者中仍然是一个具有挑战性的问题。为了尽可能保留颈椎的功能，仅当寰枕关节存在放射学或临床明显的病理状况或齿状突明显向上移位时，才应将枕骨纳入融合范围。为防止脊髓发生不可逆损伤，建议早期进行手术稳定治疗。本文对26例类风湿性关节炎患者采用改良Brattström技术进行枕颈融合的临床和放射学结果进行了回顾性分析。所遇到的并发症主要归因于钢丝固定的使用、骨水泥加固以及寰枢椎半脱位复位不充分。
