经口咽Ⅱ型前路寰枢椎复位钢板内固定系统在难复性寰枢椎脱位中的应用  

Clinical study of type Ⅱ transoral atlantoaxial reduction plate for treatment of irreducible atlantoaxial dislocation

作　　者：尹庆水[1] 夏虹[1] 吴增晖[1] 昌耘冰[1] 权日[1] 艾福志[1] 章凯[1] 麦小红[1] 刘晖[1] 何帆[1] 刘景发[1] 

机构地区：[1]广州军区广州总医院骨科,510010

出　　处：《中华创伤杂志》2007年第1期8-11,共4页Chinese Journal of Trauma

基　　金：广东省自然科学基金团队资助项目（20023001）;广东省医学科研基金资助项目（A2005500）;广东省科技计划资助项目（2004B34001012）

摘　　要：目的 评价经口咽改良Ⅱ型前路寰枢椎复位钢板（type Ⅱ transoral atlantoaxial reduction plate，TARP-Ⅱ）内固定治疗难复性寰枢椎脱位的临床效果。方法 应用TARP-Ⅱ内固定植骨融合术并采用枢椎双皮质固定法治疗难复性寰枢椎脱位15例。按美国脊髓损伤学会（ASIA）分级：C级3例，D级10例，E级2例。ASIA运动评分（83．0±13．4）分（46-100分）。结果 平均随访10个月，15例均达到即时解剖复位，颈部疼痛和肢体麻木无力症状均不同程度改善。术后3例C级改善为D级，10例D级中的4例改善为E级，其余6例分级无变化，但术后运动评分改善为（93．5±4．0）分（82～100分），10例D级的患者术后评分增加（13．1±9．4）分（4-33分）。术后MRI示脊髓减压充分，减压改善率平均89％（82％～99％），术后3个月寰枢椎均骨性愈合。结论 Ⅱ型解剖型TARP手术操作简便可行，效果优于Ⅰ型TARP固定，对难复性寰枢椎脱位可获得好的治疗效果。Objective To evaluate the clinical effect of type Ⅱ transoral atlantoaxial reduction plate （TARP-Ⅱ） system in treatment of irreducible atlantoaxial dislocation. Methods Fifteen cases with irreducible atlantoarial dislocation were treated with TARP-Ⅱ internal fixation. According to international standard revised by American Spinal Cord Injury Association （ASIA）, there were three cases at grade C, 10 at grade D and two at grade E, with preoperative ASIA motor score of （83.0 ± 13.4） scores （46-100 scores）. Results The mean follow-up period was 10 months （3-20 months）. All cases obtained instant reduc- tion. The symptoms of neck pain and limb asthenia in all cases were alleviated at different degrees. Three cases improved from grade C to grade D. Of 10 cases at grade D, four improved to grade E and the other six had motor score increased to （93.5 ±4.0） scores （82-100 scores）. For such 10 cases, postoperative motor scores increased for （13.1 ± 9.4） scores （4-33 scores） compared with preoperative ones. MRI showed that atlanto-axial bone was healed after three months and that the spine cord was decompressed thoroughly postoperatively, with mean improvement rate of 89% （82% - 99% ）. Conclusion TARP-Ⅱ procedure is simple and suitable for irreducible atlantoaxial dislocation, with better clinical effect than type Ⅰ TARP.

关 键 词：寰枢关节 脱位 内固定器 

分 类 号：R686[医药卫生—骨科学]