摘要目的 探讨颈胸结合部疾患手术入路和手术方式的选择及其重建的稳定性.方法 2001年1月至2009年2月,手术治疗颈胸结合部(C7～T2)疾患86例.患者平均年龄43.1岁(17～70岁).行前路手术57例(植骨融合38例,椎间融合器融合5例,钛网植入14例),后路手术21例(椎弓根螺钉固定9例,侧块螺钉+椎弓根螺钉固定12例),前后联合入路8例.对53例颈胸结合部脊柱脊髓损伤者采用美国脊髓损伤协会(American Spinal Injury Association,ASIA)评分,对其余33例颈胸结合部病变者采用日本矫形外科学会(Japanese Orthopaedic Association,JOA)评分评价神经功能恢复情况.Bohlman X　线标准判定植骨融合及脊柱生理曲度、椎间隙高度的恢复情况.结果　69例患者获3～45个月随访,平均12.4个月.ASIA评分术前平均1.8,术后2.3分；JOA评分术前平均10.3分,术后12.8分,术后改善率为38.0％.按Bohlman标准,植骨均融合,62例颈胸段椎间隙高度及生理曲度恢复.术后1例出现呼吸功能障碍,1例脑脊液漏,2例声音嘶哑,1例复查时出现螺钉松动.结论　颈胸结合部疾患重建手术如适应证、入路及重建方式选择正确,能够恢复椎间隙高度、生理曲度及颈椎序列.手术入路及重建方法的选择应根据病变部位、种类、致压因素、损伤类型及程度、脊柱稳定性及术者经验等因素综合考虑.

abstractsObjective To discuss the selection of surgical approach,operative methods,and stability of reconstitution of affection of cervicothoracic junction.Methods From January 2001 to February 2009,86cases with affection of cervicothoracic junction were treated surgically.The mean age of patients at the time of surgery was 43.1 years (range,17-70).Fifty-seven patients were treated with anterior approach (fixation with autologous bone grafts was done in 38 patients,Cage fixation in 5,titanium mesh in 14),21 with posterior approach (the fixation of lateral mass screw combined with pedicle screw was used in 12 patients,fixation with pedicle screw in 9),and 8 with anterior combined posterior approach.The neurological function of 53 cases of injury of cervicothoracic junction was assessed by American Spinal Injury Association (ASIA) criteria,and the rest was assessed by Japanese Orthopaedic Association (JOA) criteria; bone arthrodesis and restoring lordosis of cervical spine were assessed by Bohlman radiographic criteria.Results Sixty-nine cases were followed up for an average of 12.4 months (range,3-45).ASIA score increased from 1.8 preoperatively to 2.3 postoperatively,and JOA score increased from 10.3 preoperatively to 12.8 postoperatively.Bone fusion reached in all patients,and lordosis of the cervical spine of 62 cases was restored.One case with respiratory dysfunction,1 case with cerebrospinal fluid leakage,2 cases with hoarseness,and 1 case with loose lateral mass screw were found after the surgery.Conclusion The advantages of surgical reconstitution of the cervicothoracic junction included promoting recovery of neurological function,restoring the alignment and lordosis of the cervical spine,decreasing the rate of complication,which were dependent on the suitable surgical indications,surgical approach,and way of surgical reconstitution.The selection of reconstituted methods depends on disease,lesion site,type and degree of injury,experience of doctor,decompression and spinal stabilization synthetically.