Wertheim S B, Bohlman H H
J Bone Joint Surg Am. 1987 Jul;69(6):833-6.
Thirteen patients who underwent occipitocervical fusion that was performed using the same operative technique were followed for an average of 3.6 years (range, two to seven years). The indications for surgery were occipitocervical instability, neurological deficit, or intractable pain that was not responsive to non-operative treatment. Of the thirteen patients, eight had rheumatoid arthritis, two had atlanto-axial osteomyelitis, and one patient each had trauma, ankylosing spondylitis, and atlanto-occipital osteoarthritis. At follow-up, all of the thirteen patients had a solid arthrodesis and relief of severe pain in the neck. Of the ten patients who had had myelopathy preoperatively, all improved, but of four patients who had been unable to walk preoperatively because of severe motor involvement, only one was considered to be able to walk. Of the thirteen patients, ten had a satisfactory result. Occipitocervical arthrodesis using iliac grafts and the wiring technique that is described herein achieves immediate stable fixation, allowing early mobilization with a successful arthrodesis, and it should be undertaken before severe myelopathy occurs in patients who have instability of the cervical spine. The operation may optimize the patient's chances of neurological recovery.
13例采用相同手术技术进行枕颈融合术的患者，平均随访3.6年（范围为2至7年）。手术适应证为枕颈不稳、神经功能缺损或非手术治疗无效的顽固性疼痛。13例患者中，8例患有类风湿关节炎，2例患有寰枢椎骨髓炎，1例分别患有创伤、强直性脊柱炎和寰枕骨关节炎。随访时，13例患者均实现了牢固的关节融合，颈部剧痛缓解。术前患有脊髓病的10例患者均有改善，但术前因严重运动功能受累而无法行走的4例患者中，只有1例被认为能够行走。13例患者中，10例结果满意。使用髂骨移植和本文所述的钢丝技术进行枕颈关节融合术可实现即刻稳定固定，允许早期活动并成功实现关节融合，对于颈椎不稳的患者，应在严重脊髓病发生之前进行该手术。该手术可优化患者神经功能恢复的机会。
