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目的探讨寰枢椎结核定性诊断的方法和治疗方案的选择。方法 1994年1月至2004年12月共收治寰枢椎结核患者22例,均获得组织学诊断。其中3例经口腔穿刺活检,17例行CT 监测下经皮穿刺活检,2例采用术中冰冻切片获得病理诊断。手术治疗13例:其中在 Halo-vest 架固定下行前路经口腔病灶清除植骨1例,颈前路病灶清除植骨融合7例;前路病灶清除植骨融合加钛板内固定1例,后路寰枢椎问单纯植骨融合2例,颈后路枕枢钛板内固定加植骨融合术2例。保守治疗9例:8例行 Halo-vest 架固定,1例行枕颌牵引。所有病例均辅以抗痨治疗12～18个月。结果22例患者均获得随诊,随访18个月～7年,平均37个月。有脊髓压迫症状者完全恢复,X 线片见植骨融合,CT 片见病灶修复并有骨愈合,治疗效果满意。结论对于寰枢椎结核,穿刺活检能获得定性诊断。有无寒性脓肿、病理骨折、寰枢椎脱位及脊髓压迫是选择治疗方法的依据。
Objective To explore the methods of qualitative diagnosis of atlantoaxial tuberculosis and the choice of treatment options. Methods Twenty-two patients with atlantoaxial tuberculosis were admitted from January 1994 to December 2004, and histological diagnosis was obtained. Among them, 3 patients underwent oral biopsy, 17 underwent percutaneous needle biopsy under CT and 2 patients underwent intraoperative frozen section for pathological diagnosis. Surgical treatment of 13 cases: one in Halo-vest stent fixed descending anterior debridement in 1 case of anterior debridement, anterior cervical debridement and fusion in 7 cases; anterior debridement and bone graft fusion plus titanium plate fixation in 1 case, Posterior atlantoaxial intervertebral grafting simple fusion in 2 cases, posterior cervical spinal pillow fixation with bone fusion in 2 cases. Conservative treatment in 9 cases: 8 cases of Halo-vest stent fixation, 1 case of mandibular traction. All cases were supplemented with anti-tuberculosis treatment for 12 to 18 months. Results All the 22 patients were followed up for 18 months to 7 years with an average of 37 months. Patients with symptoms of spinal cord compression were completely restored, see X-ray bone graft fusion, CT film see the lesion repair and bone healing, the treatment effect is satisfactory. Conclusions For atlantoaxial tuberculosis, biopsy can be qualitatively diagnosed. There is no cold abscess, pathological fracture, atlantoaxial dislocation and spinal cord compression is the basis for the choice of treatment.