Ghanayem A J, Leventhal M, Bohlman H H
University Hospitals Spine Institute, Cleveland, Ohio, USA.
J Bone Joint Surg Am. 1996 Sep;78(9):1300-7. doi: 10.2106/00004623-199609000-00002.
We evaluated the results for fifteen patients in whom symptomatic osteoarthrosis of the atlanto-axial joints had been treated with an atlanto-axial or occipitocervical arthrodesis between 1973 and 1990. Thirteen patients had long-term follow-up (average duration, seven years and two months; range, four years and two months to nineteen years and two months). The two remaining patients had died: one, four days postoperatively, from a cardiopulmonary arrest, and the other, one year and eight months postoperatively, from complications related to bladder cancer. Preoperatively, all fifteen patients reported pain in the occipitocervical region that increased with any attempt at rotation of the neck and was unresponsive to immobilization with a collar and to analgesics. The average duration of the symptoms before the arthrodesis was three years. One patient had acute quadriparesis. All patients had radiographic evidence of oesteoarthrosis involving the lateral atlanto-axial articulations. Four patients had atlanto-axial instability with an average of five millimeters (range, three to ten millimeters) of motion at the anterior atlanto-odontoid interval. Six patients had an associated spontaneous subaxial fusion, which was secondary to osteoarthrosis in five; three of the five also had atlanto-axial instability. Fourteen patients were managed with a posterior arthrodesis and one, with an anterior transoral arthrodesis. The procedures were performed to relieve pain, to stabilize the atlanto-axial joints, and to restore neurological function. Of the fourteen patients who were followed, thirteen had a solid fusion and one had a stable pseudarthrosis. The patient who had quadriparesis recovered. At the latest follow-up evaluation, thirteen patients had an excellent result and one had a fair result as determined with use of a modification of the criteria of Robinson et al. There were no poor results. Atlanto-axial arthrodesis can effectively relieve occipitocervical pain and correct atlanto-axial instability secondary to osteoarthrosis.
我们评估了1973年至1990年间接受寰枢关节或枕颈关节融合术治疗症状性寰枢关节骨关节炎的15例患者的结果。13例患者进行了长期随访（平均时长为7年零2个月；范围为4年零2个月至19年零2个月）。其余2例患者已死亡：1例在术后4天死于心肺骤停，另1例在术后1年零8个月死于与膀胱癌相关的并发症。术前，所有15例患者均报告枕颈部疼痛，颈部任何旋转尝试都会使其加重，使用颈托固定和服用镇痛药均无反应。融合术前症状的平均持续时间为3年。1例患者出现急性四肢瘫。所有患者均有涉及寰枢外侧关节的骨关节炎影像学证据。4例患者存在寰枢关节不稳，寰齿前间隙平均活动度为5毫米（范围为3至10毫米）。6例患者伴有下颈椎自发性融合，其中5例继发于骨关节炎；5例中的3例也存在寰枢关节不稳。14例患者接受了后路融合术，1例接受了前路经口融合术。这些手术旨在缓解疼痛、稳定寰枢关节并恢复神经功能。在接受随访的14例患者中，13例实现了牢固融合，1例有稳定的假关节形成。出现四肢瘫的患者康复了。在最近的随访评估中，根据对Robinson等人标准的修改进行判定，13例患者结果为优，1例为良。没有结果为差的情况。寰枢关节融合术可有效缓解枕颈部疼痛，并纠正继发于骨关节炎的寰枢关节不稳。
