寰枢椎脱位规范化诊治的临床研究  

Clinical study on standardized diagnosis and treatment for atlantoaxial dislocation

作　　者：尹庆水[1] 夏虹[1] 马向阳[1] 刘景发[1] 王建华[1] 白朝晖[1] 麦小红[1] 

机构地区：[1]广州军区广州总医院骨科医院,510010

出　　处：《中国骨科临床与基础研究杂志》2012年第3期165-172,共8页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：军队医学科学技术研究"十二.五"计划(BWS11C065);军队临床高新技术重点项目(2010gxjs032)

摘　　要：目的建立寰枢椎脱位(AAD)临床诊疗规范化流程 ,探讨 AAD 规范化诊治方案的临床效果。方法自 2003年4月至2011年8月,基于自行建立的临床诊疗规范化流程对广州军区广州总医院收治的 842 例AAD 患者进行规范化诊治,其中随访资料完整的 626 例。诊治过程包括 :(1)对根据病史、症状体征和 X 线片、CT、MRI 检查明确诊断的 AAD 患者进行双向牵引,基于双向牵引过程中复位的难易程度和转归进行分型。 (2)320 例可复型 AAD 患者中,26 例采取保守治疗,255 例采取后路寰枢椎椎弓根钉固定植骨融合术,39 例行后路组合式椎弓根内固定术;266 例难复型 AAD 患者施行经口寰枢椎复位钢板(TARP) 内固定术;40 例不可复型ADD 患者采用计算机辅助设计-快速成型 (CAD-RP)+TARP 内固定术。 (3)根据随访期间 X 线片、CT、MRI 检查结果评价寰枢椎复位、骨融合情况及颈髓减压改善程度,根据 Symon 和 Lavender 评分评估术后症状体征的缓解程度,同时评估颈椎功能及并发症发生情况。结果全组患者获随访 0.7～9.0 年,平均随访时间 24.6 个月。可复型、难复型、不可复型 AAD 患者即时解剖复位率分别为 100%、98.1%、87.5%;根据尹氏颈髓减压改善率公式,可复型、难复型、不可复型 AAD 患者平均改善率分别为 99.8%、92.6%、86.5%;按 Symon 和 Lavender 临床标准,显效率为 89.5%;颈椎活动度基本恢复正常。并发症发生情况 :内固定松动 19 例,经 TARP 或后路固定翻修手术,未再发生松钉;术后感染 8 例,其中局部感染 4 例、颅内感染 4 例,取出内固定后改行后路内固定并抗感染治疗后 6 例痊愈、2 例放弃治疗;死亡 2 例,脑梗塞 1 例,呼吸道梗阻 1 例。结论采用基于 AAD 临床诊疗规范化流程的规范化诊治方案,有助于对 AAD 患者实施规范化诊疗,临床效果满意。Objective To establish the standardized flowsheet of diagnosis and treatment for atlantoaxial dislocation （AAD）, and to explore their clinical efficacy. Methods From April 2003 to August 2011, 842 AAD patients in Guangzhou General Hospital of Guangzhou Military Command were performed based on self-designed standardized schedule for ADD diagnosis and treatment, in which 626 patients had complete follow-up records. The procedures were as followed： （1） ADD patients who had been diagnosed based on history, symptoms, signs, and X-ray, CT and MRI examination underwent double-directions traction, and then were classified by the degrees of difficulty of reduction, and the reduction results. （2） In 320 reducible AAD patients, 26 got conservative therapy, 255 underwent posterior C1-C2 pedicle screw fixation combined with bone graft and fusion, 39 underwent posterior combination procedures of multi CI-C2 screw-rods fixation; 266 ADD patients, whose C1-C2 reduction were difficult to achieve during the traction, were perfornaed transoral atlantoaxial reduction plate（TARP） internal fixation; 40 ADD patients, whose C1-C2 reduction couldn＇t be achieved during the traction, performed computer assisted design-rapid prototyping （CAD-RP） ＋ TARP procedure. （3） Accroding to the results of X-ray, CT and MRI examination during the follow-up, C1-C2 reduction, fusion and cervical spinal cord decompression improvement were evaluated： Postoperative improvement of symptoms and signs were assessed by Symon and Lavender scores; Cervical vertebral functions and complications were recorded at the same time. Results Patients were followed up l^om 0.7 to 9.0 years with the average of 24.6 months. Immediate anatomic reduction rate was 100% in reducible AAD patients, 98.1% in irreducible AAD patients, and 87.5% in patients whose C1-C2 reduction couldn＇t be achieved by traditional therapy; Based on Yin＇s Ibnnula of cervical spinal decompression improvement rate, tiffs average improvement rate was 99.8% in reducible

关 键 词：寰枢关节 脱位 诊断 治疗 标准 

分 类 号：R687.3[医药卫生—骨科学]