Evaluation of clinical outcomes of one-stage anterior and posterior surgical treatment for atlantoaxial tuberculosis complicated with neurological damage
Evaluation of clinical outcomes of one-stage anterior and posterior surgical treatment for atlantoaxial tuberculosis complicated with neurological damage
复制标题
DOI：
10.1186/s12891-019-2539-7
复制
发表时间：
2019-04-06
影响因子：
2.3
通讯作者：
Hao, Dingjun
中科院分区：
文献类型：
--
作者：
Wang, Biao;Shang, Rongan;Hao, Dingjun
背景寰枢椎结核的治疗主要是以神经系统损害为主。但寰枢关节周围解剖结构复杂，椎体位置深，增加了手术难度，对术者制定手术策略具有挑战性。方法2005年1月至2015年1月，对12例合并神经功能缺损的寰枢椎结核患者采用一期前后路联合手术治疗。术前CT及MRI均显示单侧或双侧寰椎外侧块性破坏，齿状突不同程度破坏，寰枢椎稳定性丧失，结核病灶突入椎管，脊髓受压。术前按美国脊柱损伤协会（ASIA）分级标准，C级4例，D级8例。12例患者术前、术后均采用四联敏感抗结核药物治疗。比较术前及末次随访时患者的视觉疼痛评分（VAS）、颈功能障碍指数（NDI）、日本骨科协会（乔亚）评分及ASIA分级，评价患者的临床症状及神经功能恢复情况。术中出血量平均529.2 ± 169.8ml。平均融合时间为7.3 ± 1.5个月。在6.5 +/-2.9年的随访期间，未观察到内固定器械松动、移位或断裂。末次随访时VAS、NDI和乔亚评分分别为1.00 ± 0.95、9.50 ± 3.34和15.42 ± 1.44（P
BackgroundSurgical treatment is mainly used for atlantoaxial tuberculosis with neurological damage. However, the anatomic structure around the atlantoaxial joint is complex, and the position of vertebral body is deep, which increases the difficulty of the operation and it is challenging for the surgeon to develop surgical strategy. The purpose of this study was to evaluate the clinical outcomes of one-stage combined anterior and posterior surgical treatment approach for atlantoaxial tuberculosis with neurological impairment.MethodsFrom January 2005 to January 2015, 12 patients suffering from atlantoaxial tuberculosis with neurological impairment were surgically treated by one-stage combined anterior and posterior approach. Preoperative CT scanning and MRI imaging showed unilateral or bilateral lateral mass destruction of the atlas, and varying destruction degrees of odontoid process, loss of atlantoaxial stability, and tuberculosis focus into the spinal canal resulting in the corresponding spinal cord compression in all patients. The preoperative neurological classifications were Class C for 4 cases, D for 8 cases according to the American Spinal Injury Association (ASIA) system. Quadruple sensitive anti-TB drug treatment was used in all 12 patients preoperative and postoperative. Patients' clinical symptoms and neurological function recovery were evaluated by comparing the Visual Analogue Scale (VAS) score, Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) score and ASIA grading before operation and at the final follow-up.ResultsMean surgical duration was 263.343.6min. Intraoperative blood loss was averagely 529.2 +/- 169.8ml. The average fusion period was 7.3 +/- 1.5months. No instrumentation loosening, migration or breakage was observed during the follow-up of 6.5 +/- 2.9years. The VAS, NDI and JOA scores were significantly changed to 1.00 +/- 0.95, 9.50 +/- 3.34 and 15.42 +/- 1.44 at last follow-up (P