Ranawat C S, O'Leary P, Pellicci P, Tsairis P, Marchisello P, Dorr L
J Bone Joint Surg Am. 1979 Oct;61(7):1003-10.
Spinal fusion for deformity of the cervical spine was done in thirty-three patients with rheumatoid arthritis. The average follow-up was three years. The deformities present were atlano-axial subluxation, superior migration of the odontoid process into the foramen magnum, and subaxial subluxation of the vertebral bodies. We devised a classification of the pain and the neural involvement in these patients and a new method of measuring superior migration. The surgical procedures for treating instability, intractable pain, or neural involvement, or a combination of the three, were: (1) a Gallie fusion of the first and second cervical vertebrae for atlanto-axial subluxation, (2) a fusion of the occiput and the second cervical vertebra for superior migration of the odontoid process, and (3) a posterior fusion for subaxial subluxation. The occiput was included in the fusion if superior migration of the odontoid process was demonstrated. The results show that four of five patients who had an anterior fusion had no improvement. Twenty-five patients had posterior fusion; in seventeen the condition was improved, in five there was improvement, and in three the condition was worse. Of nineteen patients with neural involvement, the condition was improved in eight, it was unchanged in seven, and it was made worse in two. There were three postoperative deaths and six additional unrelated deaths within two years of surgery. There were five pseudarthroses.
对33例类风湿性关节炎患者进行了颈椎畸形的脊柱融合术。平均随访时间为3年。存在的畸形包括寰枢椎半脱位、齿突向上移入枕骨大孔以及椎体的下颈椎半脱位。我们对这些患者的疼痛和神经受累情况进行了分类，并设计了一种测量齿突向上移位的新方法。治疗不稳定、顽固性疼痛或神经受累或三者兼有的手术方法为：（1）对寰枢椎半脱位行第一和第二颈椎的Gallie融合术；（2）对齿突向上移位行枕骨和第二颈椎的融合术；（3）对下颈椎半脱位行后路融合术。如果证实齿突向上移位，则将枕骨纳入融合范围。结果显示，5例行前路融合术的患者中有4例无改善。25例行后路融合术；其中17例病情改善，5例有改善，3例病情恶化。19例有神经受累的患者中，8例病情改善，7例无变化，2例病情加重。术后有3例死亡，术后两年内另有6例与手术无关的死亡。有5例假关节形成。
