一期前路松解后路椎弓根钉固定融合治疗难复性寰枢椎脱位  

One-stage anterior release combined posterior pedicle screw internal fixation and fusion for treatment of irreducible atlantoaxial dislocation

作　　者：童杰[1] 刘社庭[1] 刘晓岚[1] 房佐忠[1] 谭震[1] 胡文军[1] 兰图[1] 

机构地区：[1]湖南省郴州市第一人民医院脊柱外科,湖南郴州423000

出　　处：《颈腰痛杂志》2011年第4期268-272,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨经口咽入路前路松解一期后路寰枢椎椎弓根钉内固定植骨融合治疗难复性寰枢椎前脱位的临床疗效。方法 2005年1月-2010年2月,采用经口咽入路前路松解,一期后路寰枢椎椎弓根钉内固定植骨融合治疗难复性寰枢椎脱位合并高位颈脊髓压迫共21例。男15例,女6例;年龄26-70岁,平均51岁;病程6-30年。陈旧性齿状突骨折13例,寰椎横韧带断裂5例,游离齿突小骨3例。所有患者均有不同程度的脊髓压迫症状。术前JOA评分7-12分,平均9.1分。影像学检查均证实寰枢椎脱位,术前平均颈髓角122.3°,寰枢椎处最小椎管矢状径平均11.5 mm。结果所有患者均获随访,随访时间12~60个月,平均26个月。术中无血管、神经损伤。术后6-12个月,所有患者均获得骨性融合,无内固定失败及复位丢失。术后神经功能明显改善J,OA评分11-16分,平均14.5分。术后平均颈髓角155.8°,最小椎管矢状径平均18.4 mm。结论经口咽入路前路松解一期后路寰枢椎椎弓根钉内固定植骨融合术安全,疗效可靠,是治疗难复性寰枢椎脱位较好的方法。Objective To explore the clinical outcome of one-stage anterior transoral release combined with posterior atlantoaxial pedicle screw fixation and bone graft fusion for treatment of irreducible atlantoaxial dislocation.Methods From Jan 2005 to Feb 2010,a total of 21 patients with cervical spinal cord compression due to irreducible atlantoaxial dislocation underwent one-stage anterior transoral release combined with posterior reduction,fixation and bone graft fusion by atlantoaxial pedicle screw instrumentation.There were 15 males and 6 females,and the average age were 51 years（range,26~70 years）.The duration of disease were range from 6 years to 30 years.The pedicle screw fixation was employed in 13 patients with old odontoid fracture,in 5 patients with traumatic disruption of transverse atlantal ligament and 3 patients with congenital odontoid disconnection.All patients had symptoms of cervical spinal cord compression,such as dyscinesia and hypoesthesia of extremities,tendon hyperreflexia and hypermyotonia.The Japanese Orthopaedic Association（JOA）score before operation was from 7 to 12,with an average of 9.1.The image examination showed atlantoaxial dislocation in all patients.The average cervico-medullary angle before operation were 122.3°,the mean minimum sagittal diameter of atlantoaxial canal was 11.5mm.Results All patients were followed up for 12~60 months,with an average of 26 months.No postoperative complications such as vertebral artery injury,exacerbation of neurological symptoms.Bony fusion was observed after 6 to 12 months of operation,no failure of internal fixation and losing of reduction.The JOA score after operation was from 11 to 16,with an average of 14.5.The average cervico-medullary angle after operation were 155.8°and the spinal canal volume enlarged apparently,the mean minimum sagittal diameter of atlantoaxial canal was 18.4mm.Conclusion One-stage anterior transoral release combined with posterior atlantoaxial pedicle screw fixation and bone graft fusion is safe and feasible for the

关 键 词：上颈椎 寰枢椎脱位 椎弓根螺钉 内固定 

分 类 号：R684[医药卫生—骨科学]