Mori T, Matsunaga S, Sunahara N, Sakou T
Department of Orthopaedic Surgery, Faculty of Medicine, Kagoshima University, Japan.
Clin Orthop Relat Res. 1998 Jun(351):169-79.
The relief of myelopathy usually is unsatisfactory by a conventional Gallie type atlantoaxial fusion for patients with rheumatoid arthritis who have irreducible atlantoaxial dislocation. To accomplish a decompressive laminectomy of the atlas in the treatment of myelopathy, the authors have been performing a new surgical procedure since 1985 for occipitocervical fusion using a rectangular rod. The postoperative outcomes for 25 patients with rheumatoid arthritis were evaluated clinically and radiographically with a 3- to 11-year (mean, 6.5 years) followup. A decompressive laminectomy of the atlas accompanied the fusion in 21 of the 25 patients. The incidence of occipital or nuchal pains improved notably in most cases, and myelopathy was relieved in 12 of 18 (67%) cases, showing an improvement of more than one level based on Ranawat's criteria. No serious postoperative complications were seen, except for one case of a failed bone union. The cumulative survival in patients with myelopathy was 79.4% in the first 5 years after operation and 27.5% at 10 years. Occipitocervical fusion using a rectangular rod accompanied by a decompressive laminectomy of the atlas can contribute to the relief of a neurologic deficit in an irreducible atlantoaxial dislocation in rheumatoid arthritis.
对于类风湿性关节炎合并不可复位寰枢椎脱位的患者，采用传统的Gallie式寰枢椎融合术缓解脊髓病通常效果不佳。为了在治疗脊髓病时完成寰椎减压椎板切除术，自1985年以来，作者一直在采用一种使用矩形棒进行枕颈融合的新手术方法。对25例类风湿性关节炎患者进行了术后3至11年（平均6.5年）的临床和影像学评估。25例患者中有21例在融合的同时进行了寰椎减压椎板切除术。大多数病例中枕部或颈部疼痛的发生率显著改善，18例中有12例（67%）脊髓病得到缓解，根据Ranawat标准显示改善超过一个级别。除1例骨不连失败外，未见严重术后并发症。脊髓病患者术后5年的累积生存率为79.4%，10年时为27.5%。采用矩形棒进行枕颈融合并同时进行寰椎减压椎板切除术有助于缓解类风湿性关节炎不可复位寰枢椎脱位患者的神经功能缺损。
