颅颈交界畸形中寰枢椎脱位的个体化治疗  

Individualized treatment of the atlantoaxial dislocation in craniovertebral junction abnormalities

作　　者：尹一恒[1] 余新光[1] 周定标[1] 卜博[1] 李连峰[1] 王鹏[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中华外科杂志》2013年第3期203-206,共4页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目（30973032）

摘　　要：目的分析颅颈交界畸形中寰枢椎脱位的特点，探讨其手术策略制定。方法分析2009年4月至2011年11月手术治疗的56例颅颈交界畸形伴寰枢椎脱位患者资料，包括2例可复性脱位和54例难复性脱位；其中男性22例，女性34例，年龄9～56岁，平均34岁。14例采用后路固定达到直接复位或部分复位，41例进行了经口前路减压和后路固定融合术，1例经后路行齿状突磨除和固定融合术。结果53例患者获得随访，3例失访（出院时症状较术前改善）；随访时间6～36个月，平均20个月。术后7例患者出现并发症，包括脑脊液漏2例、肺部感染2例、局部肉芽肿样病变1例、切口延期愈合1例，经对症处理后均恢复；l例出现不可逆性颈髓损伤，遗留四肢肌力下降。末次随访时Nurick分级，6例（11．3％）较术前改善3级，30例（56．6％）改善2级，13例（24．5％）改善1级，3例（5．7％）无明显改善，1例（1．9％）加重。结论可复性寰枢椎脱位行后路固定即可达到复位效果，难复性寰枢椎脱位治疗方式要个体化，依据病情、影像学表现和临床经验采用直接复位固定术或经口齿状突磨除及后路固定融合术。Objectives To analyze the clinical characteristics of the atlantoaxial dislocation （AAD） in craniovertebral junction （CVJ）abnormalities and to study the setup of its surgery strategy. Methods From April 2009 to November 2011, 56 patients of AAD and CVJ abnormalities including 22 male and 34 female patients who had received surgery were analyzed. There were 2 cases of reducible AAD and 54 cases of irreducible AAD. The age of the patients ranged from 9 to 56 years （mean 34 years ）. Among them, 14 cases achieved reduction/partial reduction via direct posterior fixation, 41 cases had transoral anterior deconpression and occipito-cervicaL/C1 -C2 fusion and 1 case had the posterior odontoidectomy and spinal fusion. Results Fifty-three cases had a follow-up between 6 months and 36 months （mean 20 months） and 3 cases lost follow-up （had improvement at discharge）. Seven cases had complications as follows： 1 case had irreversible spinal cord injury and muscle weakness of extremities, 2 cases had cerebrospinal leak, 2 cases had pulmonary infection, 1 case had local granuloma hyperplasia and 1 case had delayed healing of the incision. The later 6 cases all got recovery after reasonable treatments. The grades of Nurick at last follow-up were as follows： 6 cases （ 11.3% ） improved by 3 grades, 30 cases （56. 6% ） improved by 2 grades, 13 cases （24. 5% ） improved by 1 grade, 3 cases （5. 7% ） without change , 1 case （ 1.9% ） get worse. Conclusions Reducible AAD could achieve direct reduction and fixation via posterior pathways. Irreducible AAD needs individualized treatment. To choose the direct reduction and fixation or transoral odontoidectomy and posterior fixation and fusion should consider the pathogenetic condition, the image data and personal clinical experience.

关 键 词：寰枢关节 畸形 减压术 外科 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]