成人非创伤性慢性寰枕脱位的诊断与手术治疗（附二例报告）  

The diagnosis and surgical treatment of nontraumatic chronic occipitoatlantal dislocation in adults - two cases report

作　　者：许尚臣[1] 张凯宁[2] 邢毅[1] 张虎[2] 赵光宇[1] 庞琦[1] 

机构地区：[1]山东大学附属省立医院神经外科,济南250021 [2]山东大学附属山东省千佛山医院脊柱外科

出　　处：《中华神经外科杂志》2009年第9期778-780,共3页Chinese Journal of Neurosurgery

摘　　要：目的报告2例成人非创伤性慢性寰枕脱位病例，以提高其诊治水平。方法1例为58岁女性，进行性四肢无力10年；1例为18岁男性，进行性四肢无力半年。头颅CT和MRI示寰枕后脱位，斜坡下部压迫延髓，伴小脑扁桃体下疝和脊髓空洞。手术包括：经口咽人路切除斜坡下部、颅骨牵引及二期经后路颅颈固定融合。结果术后四肢肌力改善，延髓减压充分，小脑扁桃体复位，脊髓空洞缩小。结论三维重建CT和MRI是诊断非创伤性寰枕脱位的好方法，前路减压联合后路颅颈固定融合对治疗非创伤性慢性寰枕脱位安全有效。Objective No reports on experience with treating nontraumatic chronic occipitoatlantal dislocation（OAD） in adults can be found. We reported two cases treated successfully to improve the diagnosis and surgical treatment of nontraumatic chronic OAD. Method The two patients（ 58 yrs, female ＆ 18 yrs, male） presented with progressive weakness in both sides of upper and lower limbs for 10 years and half a year respectively, without history of trauma. CT and MRI confirmed the diagnosis of OAD with syringomyelia. Surgical procedures included lower clivus removal via transoral approach, cranial traction, and posterior occipitocervical fixation and fusion. Results Clinically, neurological deficits were remarkably improved. Postoperative imaging studies showed good realignment of occipito - atlanto - axial complex with comfortable decompression of brainstem. The syringomyelia was relieved remarkably. Conclusions Anterior tranoral decompression by removing the lower part of the clivus combined with cranial retraction and posterior fixation can be adopted in the treatment of nontraumatic chronic OAD.

关 键 词：寰枕关节 脱位 减压术 外科 后路颅颈融合 

分 类 号：R686[医药卫生—骨科学]