内镜辅助经颈前路松解后路内固定治疗难复性寰枢关节脱位远期疗效分析  

Long term outcome of endoscopic transcervical anterior release and posterior fixation in the treatment of irreducible atlantoaxial dislocation

作　　者：马泓[1] 王冰[1] 吕国华[1] 

机构地区：[1]中南大学湘雅二医院脊柱外科,长沙410011

出　　处：《中国骨与关节杂志》2016年第5期344-348,共5页Chinese Journal of Bone and Joint

摘　　要：目的分析内镜辅助经颈前路松解后路内固定术治疗难复性寰枢关节脱位（irreducible atlantoaxial dislocation,IAAD）的远期疗效。方法回顾性分析2005年3月至2010年7月,39例在我院接受内镜辅助经颈前路松解后路内固定手术治疗的IAAD患者的临床资料,其中男16例,女23例,年龄5-65岁,平均（36.7±14.9）岁。合并寰枕融合8例,类风湿关节炎5例,原发性颅底凹陷症21例。比较术前、术后3个月、术后1年和末次随访时行颈痛视觉模拟评分（visual analogue scale,VAS）和日本骨科学会（Japanese orthopedic association,JOA）评分,测量寰齿前间距（anterior atlanto-odontoid interval,AADI）和颈髓延髓角（cervico medullary angle,CMA）,并行统计学分析。结果随访时间60-79个月,平均（69.7±7.3）个月,颈痛VAS、JOA评分在术后3个月时和术前比较、末次随访时和术后3个月比较改善,差异有统计学意义（P〈0.05）;AADI、CMA值术后3个月和术前比较改善,差异有统计学意义（P〈0.05）,末次随访和术后3个月比较,差异无统计学意义（P〉0.05）。所有病例的神经功能均得到不同程度改善,术前平均JOA评分为（11.6±3.3）分,末次随访时平均（16.2±2.3）分,无内固定失败、假关节等并发症发生,CT证实均达到骨性融合。结论内镜辅助经颈前路松解后路内固定治疗IAAD可以有效改善临床症状,降低并发症发生,并长期维持寰枢关节正常解剖结构。Objective To analyze the long term outcome of endoscopic transcervical anterior release and posterior fixation in the treatment of irreducible atlantoaxial dislocation （ IAAD ）. Methods Totally 39 cases with IAAD underwent endoscopic transcervical anterior release and posterior fixation from March 2005 to July 2010. There were 16 males and 23 females with the average age of （ 36.7 ± 14.9 ） years. Eight cases had C1 occipitalization, 5 cases had rheumatoid arthritis, 21 cases had basilar invagination. Visual analoge scale （ VAS ） score for cervical pain, Japanese orthopedic association （ JOA ） score, anterior atlanto-odontoid interval （ AADI ）, cervicomedullary angle （ CMA ） at preoperation, 3 months, 1 year and final follow-up after surgery were reviewed statistically. Results The average follow-up period was （ 69.7 ± 7.3 ） months. As for VAS cervical pain and JOA score： significant differences （ P 〈 0.05 ） were noticed between 3 months＇ follow-up and preoperation, last follow-up and 3 months＇ follow-up. As for AADI and CMA, significant differences （ P 〈 0.05 ） were noticed between 3 months＇ follow-up and preoperation, whereas no significant differences （ P 〉 0.05 ） were seen between last follow-up and 3 months＇ follow-up. During follow-up, all cases showed improvement of neurological function, the JOA scores were improved from （ 11.6± 3.3 ） points preoperatively to （ 16.2 ± 2.3 ） points at last follow-up. No complication such as fixation failure, pseudarthrosis were witnessed during follow-up. Solid fusion was confirmed by CT in all cases. Conclusions Endoscopic transcervical anterior release and posterior fixation for IAAD can improve clinical outcomes, decrease postoperative complication as well as restore and maintain the normal atlantoaxial facet joint anatomy in long term.

关 键 词：外科手术 微创性 内窥镜 颈椎 寰枢关节 脱位 

分 类 号：R687.4[医药卫生—骨科学]