前、后路手术治疗寰枢关节脱位的临床疗效分析  

Clinical efficacy of anterior and posterior surgery for atlantoaxial dislocation

作　　者：庞广兴[1] 刘先银[1] 吴增晖[2] 陈旭琼[2] 黎松波[1] 汪宇[1] 

机构地区：[1]广东省东莞市人民医院骨科二区,广东东莞523000 [2]广东省广州军区广州总医院骨科,广东广州510010

出　　处：《广东医学院学报》2015年第3期312-315,共4页Journal of Guangdong Medical College

摘　　要：目的观察前、后路手术治疗寰枢关节脱位的安全性及临床疗效。方法 2009年5月-2013年7月我科对10例可复型寰枢关节脱位患者施行后路寰枢椎椎弓根螺钉固定融合术,1例难复型寰枢关节脱位经口咽松解复位TARP钢板（transoral atlantoaxial reduction plate）内固定融合术。术后复查颈椎影像学,观察寰枢关节复位情况,按JOA（Japanese Orthopaedic Association Scores）评分标准行术前、后颈髓神经功能评分,观察手术并发症及植骨融合情况。结果全组病例均获得寰枢关节解剖复位,未发生椎动脉损伤、脊髓损伤、切口感染及脑脊液漏等并发症;全组病例随访时间为14∽31个月,平均23.3个月;术后颈髓神经功能改善率达54.0%;术后3-6个月X线片及CT显示植骨融合。结论前、后路手术治疗寰枢关节脱位安全可行,术后可获得良好的复位及神经功能改善。Objective To observe safety and clinical efficacy of anterior and posterior surgery for atlantoaxial dislocation.Method From May 2009 to July 2013, 10 adult patients with reducible atlantoaxial dislocation were treated with posterior C1-C2 pedicle screws fixation combined with bone graft and fusion under general anesthesia, and 1 adult patient with irreducible atlantoaxial dislocation underwent transoral atlantoaxial reduction plate（TARP） internal fixation under general anesthesia. Cervical spine imaging was re-examined after operation to observe restoration of atlanto-axial joints. Preoperative and postoperative cervical spinal nerve function was scored according to Japanese Orthopaedic Association Scores（JOA）, and surgical complications and bone fusion was observed. Results All the cases achieved anatomic reduction of atlanto-axial joint with no occurrence of complications including vertebral artery injury, spinal cord injury, incision infections and leakage of cerebrospinal fluid; A1 l patients were followed up for 14- 31 months with an average of 23.3 months; postoperative neurological improvement rate was up to 54.0%; X-ray and CT showed bone fusion 3-6 months after operation. Conclusion Anterior and posterior surgery for atlantoaxial dislocation is safe and feasible, and patients can achieve good restoration and neurological improvement after operation.

关 键 词：寰枢关节脱位 前、后路手术 临床疗效 

分 类 号：R687[医药卫生—骨科学]