3D显微镜下经口松解复位二期后路内固定治疗难复性寰枢关节脱位  

Secondary posterior internal fixation after transoral anterior atlantoaxial release under 3D operative microscopy for irreducible atlantoaxial dislocation

作　　者：刘屹林[1] 王玉强[1] 杨浩[1] 阮天臣 李朋飞 熊英杰 王利民[1] 张杨[1] Liu Yilin;Wang Yuqiang;Yang Hao;Ruan Tianchen;Li Pengfei;Xiong Yingjie;Wang Limin;Zhang Yang(Department of Orthopaedics, The First Affiliated Hospital to Zhengzhou University, Zhengzhou 450052, Chin)

机构地区：[1]郑州大学第一附属医院骨科,450052

出　　处：《中华创伤骨科杂志》2018年第4期280-285,共6页Chinese Journal of Orthopaedic Trauma

基　　金：河南省医学科技攻关计划项目（201403053）

摘　　要：目的探讨3D显微镜下经口松解复位二期后路内固定治疗难复性寰枢关节脱位（IAD）的疗效。方法回顾性分析2014年1月至2016年5月采取3D显微镜下经口入路松解复位二期后路内固定治疗的12例IAD患者资料；男7例，女5例；年龄25～54岁，平均37．1岁；比较患者术前、术后1年的视觉模拟评分（VAS）、日本骨科协会（JOA）评分及神经功能改善率、美国脊髓损伤协会（ASIA）分级、寰齿间距（ADI）、脊髓有效空间（SAC）及颈髓脊髓角（CMA）。结果所有患者术后均获1年以上随访，寰枢关节均获解剖复位。VAS评分、JOA评分、ADI、SAC、CMA由术前（5．73±1．36）分、（9．03±2．12）分、（8．34±1．12）mm、（9．53±0．69）mm、121．23°±4．32°改善至术后1年（1．21±0．63）分、（14．32±2．51）分、（2．83±0．36）mm、（14．23±1．22）mm、153．53°±9．25°，差异均有统计学意义（P〈0．05）。其中JOA评分神经功能改善率随着术后时间的延长，逐步提高，术后1年达94．14％±5．11％。ASIA分级分布较术前明显改善，差异有统计学意义（P〈0．05）。结论3D显微镜下经口松解复位二期后路内固定治疗难复性寰枢关节脱位，随访1年寰枢关节复位效果良好，值得临床推广。Objective To explore the clinical efficacy of secondary posterior internal fixation after transoral anterior atlantoaxial release under 3D operative microscopy for treatment of irreducible atlantoaxial dislocation. Methods From January 2014 to May 2016, 12 patients with irreducible atlantoaxial dislo- cation were treated with secondary posterior internal fixation after transoral anterior atlantoaxial release under 3D operative microscopy in our hospital. They were 7 males and 5 females, with an average age of 37. 1 years （from 25 to 54 years） . The efficacy was analyzed in terms of their visual analogue scale （VAS）, Japanese Orthopaedic Association （JOA） scoring, improvement rate of neurological function, American Spinal Injury Association （ASIA） grading, atlas-dens interval （ADD, space available for the cord （SAC） and cervi- comedullary angle （CMA） before and one year after operation. Results The patients were followed up for more than one year. All the atlantoaxial joints obtained anatomic reduction. Their preoperative values of VAS （5.73± 1.36 points）, JOA score （9.03 ±2. 12 points）, ADI （8.34 ± 1.12 mm）, SAC （9.53 ±0. 69 mm） and CMA （121.23°±4.32°） were significantly improved one year after operation （1.21 ± 0.63 points, 14. 32 ±2. 51 points, 2.83 s0. 36 mm, 14.23 ±1.22 mm and 153.53°±9. 25°, respectively） （P 〈0.05） . The improvement rate of neurological function increased gradually with the postoperative time, reaching 94. 14% ±5.11% one year after operation. The postoperative ASIA grading was significantly improved too one year after operation （ P 〈 0.05） . Conclusion Secondary posterior internal fixation after transoral anterior atlantoaxial release under 3D operative microscopy may lead to fine clinical efficacy one year after operation for patients with irreducible atlantoaxial dislocation.

关 键 词：寰枢关节 脱位 骨牵引复位法 后路内固定 

分 类 号：R687.3[医药卫生—骨科学]