枕骨-枢椎螺钉间撑开复位内固定术治疗CAAD  

Treatment of Reduction between Occiput and Axial Screws in Congenital Atlantoaxial Dislocation

作　　者：徐立[1] 黄莉[1] 曹俊青 Xu Li;Huang Li;Cao Junqing(Wuhan No.1 Hospital,Wuhan,430022)

机构地区：[1]武汉市第一医院

出　　处：《基因组学与应用生物学》2018年第9期4036-4041,共6页Genomics and Applied Biology

基　　金：武汉市第一医院资助

摘　　要：为了探讨枕骨-枢椎螺钉间撑开复位内固定术在先天性寰枢关节脱位（CAAD）治疗中的作用。本研究选择2014年4月至2016年4月在西南医科大学第一附属医院收治的经枕骨-枢椎螺钉撑开复位内固定术治疗的CAAD患者17例作为研究对象,根据术前和术后影像学检查考察齿状突下降程度、延髓颈髓角变化及日本骨科协会（JOA）评分,对比患者术前、术后短期及远期疗效,并计算术后功能改善率。随访时间为4-29个月,平均14个月。研究显示,术前齿状突尖端到Chamberlain线距离平均为（10.49±2.87）mm,术后平均为（4.47±2.62）mm,术后较术前下降（p〈0.05）;术后的延髓颈髓角较术前增大（p〈0.05）;疗效如下：2例治愈（11.8%）,9例显效（52.9%）,6例有效（35.3%）,术后短期及远期功能较术前显著改善（p〈0.05）;术后短期较术后远期疗效对比差异无统计学意义（p〉0.05）。枕骨-枢椎螺钉撑开复位内固定术在CAAD中是一种安全、有效的手术方式。To investigate the role of occipital-axial screw open reduction and internal fixation in the treatment of congenital atlantoaxial dislocation（CAAD）. This study selected 17 patients with CAAD who underwent occipitalaxial screw open reduction and internal fixation in the First Affiliated Hospital of Southwest Medical University from April 2014 to April 2016. According to preoperative and postoperative imaging examination, the degree of odontoid reduction, the change of medulla oblongata cord angle and the Japanese Department of orthopedics Association（JOA）score were investigated. The preoperative and postoperative short-term and long-term effects were compared and the postoperative functional improvement rate was calculated. The follow-up period was 4 to 29 months with an average of 14 months. Studies had shown that the preoperative odontoid tip to the Chamberlain line distance is（10.4±2.87） mm, the average postoperative（4.47±2.62） mm, postoperative decline compared with preoperative（p〈0.05）; The cervical medullary angle of the medulla oblongata is larger than that before operation（p〈0.05）; The curative effects were as follows： 2 cases were cured（11.8%）, 9 cases were markedly effective（52.9%）, 6 cases were effective（35.3%）, and the short-term and long-term functions were significantly improved（p〈0.05）. There was no significant difference in short-term postoperative outcome compared with postoperative long-term outcome（p〉0.05）. Occipital-axial screw open reduction and internal fixation is a safe and effective surgical procedure in CAAD.

关 键 词：寰枢关节 先天畸形 复位 内固定器 

分 类 号：R687.3[医药卫生—骨科学]