创伤性寰枢关节旋转脱位的诊断与外科治疗(附32例报告)  

Diagnosis and Surgical Treatment of Traumatic Atlanto-axial Rotatory Dislocation(Analysis of 32 Cases)

作　　者：赵慧毅[1] 段少银[2] 华强[1] 王振辉[1] 陈辉东[1] 

机构地区：[1]厦门大学附属中山医院骨科,福建省厦门市361004 [2]厦门大学附属中山医院影像科

出　　处：《中国骨与关节损伤杂志》2009年第11期968-970,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨创伤性寰枢关节旋转脱位的诊断与外科治疗。方法自1997年1月～2008年12月收治创伤性寰枢关节旋转脱位32例,其中15例入院前被漏诊或误治。18例采取非手术治疗;14例接受手术治疗:手术包括Summit枕颈融合术内固定2例,Cervifix枕颈融合术内固定1例,Magerl寰枢椎融合术2例,C1、2侧块关节螺钉固定结合Apofix椎板夹固定4例,C1侧块、C2椎弓根钉棒固定系统内固定5例。结果27例(14例手术和13例非手术治疗)获得随访,平均4.5年。斜颈、疼痛症状消失15例,明显缓解7例,部分缓解4例,无变化1例。14例合并神经系统损伤,经治疗后神经症状均有明显好转。手术治疗的14例均获得骨性愈合。结论外伤病人如诉头颈或枕部疼痛伴头颈偏斜,要考虑寰枢关节旋转脱位的可能,并常规行上位颈椎CT薄层扫描,必要时CT三维重建。对于寰枢关节陈旧性旋转脱位或合并寰椎横韧带断裂、寰椎爆裂骨折等难复性骨折脱位,应及时进行手术治疗。Objective To investigate the feature of diagnosis and the surgical treatment of the traumatic adantoaxial rotatory dislocation. Methods Thirty-two patients with traumatic atlanto-axial rotatory dislocation were studied for this collective review since 1997.Fifteen cases were misdiagnosed before in hospital.Fonrteen patients were treated by operation.Occipito-cervical fusion was performed in 3 patients by Cervifix fixation with autologous bone grafts.Two patients were operated by C1.2 posterior wiring fixation and added adanto-axial facet screw fixation, 4 were operated on by atlanto-axial arthrodesis using Apofix interlaminar clamping with autologous bone grafts, and added atlanto-axial facet screw fixation.Five patients were operated upon by C1 lateral mass screws and C2 isthmic screws connected with rods internal fixations.Results The 27 patients were followed up for an average of 4.5 years （range, 4-92 months）.Solid arthrodesis was obtained in 14 operated patients. The patients with nerve injury before operation were 14 cases. Among them, 7 cases were recovered, 6 obviously improved, 1 case was improved after the operation.Conclusion If the patients have pains of the head and neck or the occiput after trauma, the probability of atlantoaxial rotatory dislocation should be considered. The routine roentgengrophic anteroposterior, lateral and open mouth view of the neck, the flexion and extension view,CT three dimensional reconstruction should be made. For chronic atlantoaxial rotatory dislocation, and with traumatic fracture or ligament disruption, aflanto-axiac fusion is used. C1 lateral mass screws and C2 isthmic screws connected with rods internal fixations is one of the best way of atlantoaxiac fusion fixation in current.

关 键 词：寰枢关节 旋转脱位 多层螺旋CT 骨科手术 

分 类 号：R684.7[医药卫生—骨科学] R687.32[医药卫生—外科学]