复杂寰枢椎脱位的诊断与治疗  

Diagnosis and treatment for compficated atlantoaxial dislocation

作　　者：尹庆水[1] 夏虹[1] 吴增晖[1] 艾福志[1] 马向阳[1] 章凯[1] 王建华[1] 麦小红[1] 万磊[1] 陈旭琼[1] 

机构地区：[1]广州军区广州总医院骨科,510010

出　　处：《中华外科杂志》2010年第17期1301-1304,共4页Chinese Journal of Surgery

基　　金：2007年度卫生部公益性行业科研专项基金资助项目（200802017）;广东省科技计划资助项目（2006A36001003-04）

摘　　要：目的 探讨复杂寰枢椎脱位的临床特点和处理方法.方法 回顾性分析自2005年2月至2008年10月收治的54例含有复杂因素、不能有效采取常规治疗方法的复杂寰枢椎脱位患者的临床特点和复杂因素,其中男性26例,女性28例,年龄4～65岁,平均34岁.根据不同的复杂因素采取不同的特殊处理方法,主要包括Ⅲ型经口寰枢椎复位钢板（TARP-Ⅲ）内固定术、计算机辅助设计与快速成型（CAD-RP）指导下的深部磨削减压技术、CAD-RP个性化置钉导板技术及经口扩大入路技术.结果 平均随访时间24个月,54例患者中48例获得解剖复位,6例接近解剖复位;受压颈髓减压充分,脊髓减压改善率达86.0%,神经功能改善率达77.8%.2例术后发生颅内感染,均治愈.结论 通过应用TARP-Ⅲ手术、CAD-RP指导下的深部磨削减压操作技术、CAD-RP个性化置钉导板技术和扩大手术人路等四项技术,一些复杂的寰枢椎脱位患者能够得到有效治疗.Objective To explore the clinical characteristics and treatment methods for complicated atlantoaxial dislocation.Methods A retrospective evaluation was done to summarize and analyze the clinical characteristics and complicated factors of 54 patients with complicated atlantoaxial dislocation who could not to be treated effectively by using conventional therapy in our hospital from February 2005 to October 2008.According to different complicated factors,different treatment methods mainly including transoral atlantoaxial reduction plate-Ⅲ（TARP-Ⅲ）operation,decompression procedure with deep grinding guided by computer aided design-rapid prototyping（CAD-RP）,screw placement technique with CAD-RP guideplate and extensile approach surgery were performed.Results The average follow-up period was 24 months.Among 54 cases,48 cases achieved immediate anatomic reduction completely and 6 cases almost achieved anatomical reduction.All the compressed spinal cords were decompressed sufficiently.The decompression rate was 86.0%and the improvement rate of nerve function was 77.8%.Two cases suffered postoperative intracranial infection.Conclusion Some cases of complicated atlantoaxial dislocation can be effectively treated by using TARP-Ⅲ operation,decompression procedure with deep grinding guided by CAD-RP,individualized screw placement technique with CAD-RP guide plate and extensile approach surgery.

关 键 词：寰枢关节 脱位 经口人路 内固定 

分 类 号：R687.3[医药卫生—骨科学]