后路椎弓根螺钉内固定融合术治疗强直性脊柱炎并寰枢椎脱位

摘要

Objective To investigate the therapeutic effect of posterior internal fixation and fusion plus pedicle screw in treatment of ankylosing spondylitis( AS) patients with atlantoaxial dislocation. Methods 6 patients who diagnosed with AS with atlantoaxial dislocation were performed posterior internal fixation and fusion plus atlantoaxial pedicle screw. Preoperative and postoperative JOA scores and VAS were measured to evaluate the curative effect. Results The operation time was (98. 17 ± 9. 85)min and blood loss were (301. 67 ± 34. 30)ml. All cases were followed up for 3 ~6 years. All atlantoaxial joint got bony fusion by the last follow-up without complication due to instrumentation failure. Two patients complained peripheral nerve stimulation of the occipital nerves, the symptoms relieved postoper-ation. Three cases with limbs motor and sensory disabilities, however, the symptoms relieved spontaneously within 6~12 months. There was significant difference on VAS scores between preoperation 7. 0 ± 1. 0 and postoperation 2. 2 ± 1. 2 (P<0. 01). There was significant difference on JOA scores between preoperation 7. 17 ± 2. 48 and postop-eration 13. 67 ± 2. 42 (P<0. 01). Conclusions Atlantoaxial dislocation is a common complication of AS. Posterior internal fixation and fusion plus pedicle screw is a safe and effective technique for AS patients with atlantoaxial dislo-cation.%目的：探讨经后路椎弓根螺钉系统内固定融合术治疗强直性脊柱炎( AS)并寰枢椎脱位的临床疗效。方法采用后路椎弓根螺钉系统固定融合治疗6例强AS并寰枢椎脱位患者。应用JOA颈椎评分标准和VAS评分标准评价治疗效果。结果手术时间(98．17±9．85) min,术中出血量(301．67±34．30) ml。患者均获随访,时间3~6年。6例均骨性融合,无内固定松动断裂；2例表现为枕大神经刺激症状者,术后即消失；3例伴有四肢不同程度运动及感觉障碍者,术后6个月~1年完全恢复。 VAS从术前(7．0±1．0)分降至末次随访时(2．2±1．2)分,差异有统计学意义(P<0．01)；JOA从术前(7．17±2．48)分提高至(13．67±2．42)分,差异有统计学意义(P<0．01)。结论寰枢椎脱位是AS常见并发症。后路椎弓根螺钉系统内固定融合术是治疗AS并寰枢椎脱位不稳的有效治疗方法。