难复性寰枢椎脱位的外科治疗  

Surgical management of irreducible atlantoaxial dislocation

作　　者：邵将[1,2] 贾连顺[1] 陈雄生[1] 严望军[1] 张咏[3] 康辉[1] 

机构地区：[1]上海长征医院骨科,200003 [2]解放军第八五医院骨科 [3]上海市闸北区中心医院骨科,上海200003

出　　处：《中华骨科杂志》2010年第2期192-197,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨难复性寰枢椎脱位治疗中寰枢椎松解方法的选择，应用椎弓根螺钉钉棒系统复位、固定及融合的疗效。方法对2003年12月至2008年6月收治的19例难复性寰枢椎脱位患者的病例资料进行回顾性分析。男15例，女4例；年龄11-66岁，平均41．5岁。寰椎前脱位15例，寰椎后脱位4例。14例有明确外伤史。所有患者均表现为颈部疼痛、活动受限，14例有四肢麻木、行走不稳等颈髓压迫症状。术前常规行X线、MR和CT三维重建检查，评估寰椎移位及旋转程度。根据脱位类型及移位程度选择前路和（或）后路对寰枢椎进行松解，在持续颅骨牵引下利用椎弓根螺钉进行寰椎复位、固定及髂骨块植骨融合。术后头-颈-胸支具保护12周。结果所有患者均获随访，随访时间10-60个月，平均26．4个月。患者颈部疼痛缓解，14例存在神经压迫的患者神经功能好转，脊髓ASIA残损分级提高。平均4．5个月植骨愈合。术前寰椎移位5-13mm，平均（8．7-2．6）mm，术后平均（2．6-1．2）mm；术前寰椎旋转0°-55°，平均（1713°±5．8°），术后平均（5．0°±2．4°）；两者均较术前下降，差异有统计学意义（P〈0．05）。无神经、椎动脉损伤及内固定失败、切口感染等并发症。结论对难复性寰枢椎脱位应根据脱位类型和移位程度选择相应的寰枢椎松解方法。良好的寰枢椎松解、复位结合后路椎弓根螺钉钉棒固定、髂骨块植骨融合是治疗难复性寰枢椎脱位较好的方法。Objective To investigate the atlantoaxial release method and evaluate the effects of posterior pediele screw rod system in the treatment of irreducible atlantoaxial dislocation. Methods Nine- teen patients with irreducible atlantoaxial dislocation were retrospectively analyzed, including 15 males, and 4 females, with the average age of 41.5 years （ranged 11 to 66 years）. There were 15 patients with atlas anterior dislocation, 4 with atlas posterior dislocation. All of patients complained of neck pain, neck activities restricted, and 14 of cases with symptoms of cervical spinal cord compression. All of patients received X-ray, MRI and CT three-dimensional reconstruction to measure translocation and rotation of atlas. According to the types and extent of irreducible atlantoaxial dislocation, anterior or/and posterior atlantoaxial release had been chosen. With continuous skull traction, the atlas was redueted and fixed with pedicle screws. Fusion of atlantoaxial had performed by iliac bone graft. Brace of head, neck and thoracic were kept for protection 12 weeks after surgeries. Results All patients were followed up 10-60 months, average 26.4 months. Complains of neck pain and numbness of limbs disappeared after surgery. The bone graft fused with atlantoaxial at 4.5 months in average. Translocation of atlas decreased from （8.7±2.6） mm preoperatively to （2.6±1.2） mm postoperatively. Rotation of atlas decreased from （17.3°±5.8°） preoperatively to （5.0°±2.4°） postoperatively （P〈0.05）. No nerve or vertebral artery injuries, internal fixation failures or infections were observed. Conclusion The atlantoaxial release method should be chosen, according to the types and extend of atlantoaxial dislocation. A suitable release and reduction of atlantoaxial, combining with posterior pedicle screw fixation and the iliac bone fusion is an effective treatment for irreducible atlantoaxial dislocation.

关 键 词：寰椎 枢椎 脱位 内固定器 

分 类 号：R687.3[医药卫生—骨科学]