Fehlings M G, Errico T, Cooper P, Benjamin V, DiBartolo T
Department of Neurosurgery, New York University Medical Center, New York.
Neurosurgery. 1993 Feb;32(2):198-207; discussion 207-8. doi: 10.1227/00006123-199302000-00008.
Although occipitocervical fusion is frequently used for instability of the upper cervical spine and the occipitocervical articulation, most currently used techniques have one or more of the following disadvantages: the necessity for sublaminar wires, the use of occipital screws, a fixed angle of instrumentation, or the necessity for routine postoperative halo immobilization. Moreover, many reported techniques are associated with a high rate of nonunion or instrumentation failure. We present our experience with a technically simple method of obtaining rigid occipitocervical arthrodesis using a 5-mm malleable rod that is fixed to the skull by a pair of wires passed through four suboccipital burr holes. Segmental spinal fixation is achieved with Wisconsin interspinous wires and is occasionally supplemented with sublaminar wires. Supplemental autogenous bone graft is used in all cases. A cervical collar is routinely used for postoperative immobilization. The results of treatment were retrospectively reviewed in 16 patients with an average age of 49.4 years (range, 9-69). Mean follow-up was 24 months (range, 12-36 mo). The indication for fusion was instability of the occiput-C1-C2 complex as a result of Chiari malformation, rheumatoid disease, skull base tumor resection, basilar invagination, ankylosing spondylitis, Down's syndrome, cervical laminectomy, and trauma. The average number of levels fused was 5.4 (range, O-C3 to O-T3). Successful occipitocervical arthrodesis was achieved in all but one of the surviving patients. The single patient with a pseudarthrosis was successfully managed with supplemental bone grafting and halo immobilization. There were two deaths from medical complications in chronically ill patients. Other complications included one postoperative instrumentation loosening, one myocardial infarction, and one superficial occipital decubitus. In conclusion, rodding and segmental interspinous wiring is an effective, technically simple method of obtaining rigid occipitocervical fixation, which obviates the need for bulky orthoses.
尽管枕颈融合术常用于治疗上颈椎和枕颈关节的不稳定，但目前大多数使用的技术存在以下一个或多个缺点：需要使用椎板下钢丝、使用枕骨螺钉、固定角度的器械装置，或术后常规需要头环固定。此外，许多报道的技术与不愈合率高或器械装置失败有关。我们介绍了一种技术上简单的方法，即使用一根5毫米可塑形棒通过四个枕下钻孔穿入的一对钢丝固定于颅骨，从而获得坚固的枕颈关节融合。节段性脊柱固定采用威斯康星棘突间钢丝，偶尔辅以椎板下钢丝。所有病例均使用自体骨移植作为补充。术后常规使用颈托固定。对16例平均年龄49.4岁（范围9 - 69岁）的患者的治疗结果进行了回顾性分析。平均随访时间为24个月（范围12 - 36个月）。融合的指征包括由于Chiari畸形、类风湿性疾病、颅底肿瘤切除、基底凹陷、强直性脊柱炎、唐氏综合征、颈椎椎板切除术和创伤导致的枕骨 - C1 - C2复合体不稳定。平均融合节段数为5.4个（范围O - C3至O - T3）。除一名存活患者外，所有患者均成功实现了枕颈关节融合。唯一发生假关节的患者通过补充骨移植和头环固定成功治愈。两名慢性病患者因医疗并发症死亡。其他并发症包括一例术后器械装置松动、一例心肌梗死和一例枕部浅表褥疮。总之，棒状固定和节段性棘突间钢丝固定是一种有效、技术上简单的获得坚固枕颈固定的方法，无需使用笨重的矫形器。
