Wada Keiji, Murata Yasuaki, Kato Yoshiharu
Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan.
Asian Spine J. 2015 Oct;9(5):699-704. doi: 10.4184/asj.2015.9.5.699. Epub 2015 Sep 22.
A retrospective study.
To investigate the surgical outcome for hemodialysis-related upper cervical lesions.
Surgical outcome of lower cervical lesions in patients undergoing hemodialysis has been reported. However, surgical outcome for upper cervical lesions in hemodialysis patients is unclear.
Upper cervical lesions in nine patients undergoing hemodialysis were surgically treated. Mean age at surgery was 61.6 years (range, 52-68 years), and the mean follow-up period was 45.4 months (range, 2-98 months). Patients had undergone hemodialysis for an average of 25.3 years (range, 16-40 years) at surgery. Seven patients with destructive spondyloarthropathy (DSA) of the upper cervical spine were treated with atlantoaxial or occipitocervical fixation. Two patients with retro-odontoid pseudotumors were treated with C1 posterior arch resection alone. Japanese Orthopedic Association (JOA) scores for cervical myelopathy, postoperative complications, postoperative radiography, and preoperative and postoperative occipital pain were evaluated.
Mean preoperative and postoperative JOA score was 3.7 and 8.1, respectively. The seven patients with DSA had severe preoperative occipital pain that disappeared postoperatively. Postoperative radiography showed solid bone union in DSA cases and no instability in pseudotumor cases.
Satisfactory surgical outcome was observed for hemodialysis-related upper cervical lesions.
一项回顾性研究。
探讨与血液透析相关的上颈椎病变的手术效果。
已有报道血液透析患者下颈椎病变的手术效果。然而，血液透析患者上颈椎病变的手术效果尚不清楚。
对9例接受血液透析的患者的上颈椎病变进行手术治疗。手术时的平均年龄为61.6岁（范围52 - 68岁），平均随访期为45.4个月（范围2 - 98个月）。患者手术时平均已接受血液透析25.3年（范围16 - 40年）。7例上颈椎破坏性脊椎关节病（DSA）患者接受了寰枢椎或枕颈固定治疗。2例齿突后假瘤患者仅接受了C1后弓切除术。评估了日本骨科学会（JOA）的颈椎病评分、术后并发症、术后影像学检查以及术前和术后的枕部疼痛情况。
术前和术后JOA评分的平均值分别为3.7和8.1。7例DSA患者术前有严重的枕部疼痛，术后消失。术后影像学检查显示DSA病例有坚实的骨愈合，假瘤病例无不稳定情况。
观察到与血液透析相关的上颈椎病变的手术效果令人满意。
