经颈前咽后入路前路松解二期后路复位融合内固定术治疗难复性寰枢关节脱位  

Atlantoaxial joint release through anterior retrophayngeal approach and staged posterior reduction fixation and fusion for irreducible atlantoaxial dislocation

作　　者：袁杨 雷飞[3] 周春光 刘立岷[1] 宋跃明[1] YUAN Yang;LEI Fei;ZHOU Chunguang;LIU Limin;SONG Yueming(Department of Orthopaedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China;Department of Orthopaedics,the People＇s Hospital of Pengzhou,Pengzhou Sichuan,611930,P.R.China;Department of Spinal Surgery,the Affiliated Hospital of Southwest Medical University,Luzhou Sichuan,646000,P.R.China)

机构地区：[1]四川大学华西医院骨科,成都610041 [2]彭州市人民医院骨科,四川彭州611930 [3]西南医科大学附属医院脊柱外科,四川泸州646000

出　　处：《中国修复重建外科杂志》2018年第11期1377-1381,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨经颈前咽后入路前路松解二期后路复位融合内固定术治疗难复性寰枢关节脱位的疗效。方法 2012年2月—2016年8月,收治15例难复性寰枢关节脱位患者。男9例,女6例;年龄14～53岁,平均31.4岁。病程3个月～17年,平均5.7年。其中因外伤后继发寰枢关节脱位13例,先天性齿状突不连继发寰枢关节脱位2例。术前影像学检查均提示寰枢关节脱位,在功能位上无法自行复位。疼痛视觉模拟评分(VAS)为3～7分,平均4.1分;日本骨科协会(JOA)评分为10～17分,平均13.8分。采用一期经颈前咽后入路前路松解后,继续颅骨牵引,二期经后路复位植骨融合内固定术治疗。结果所有患者均达解剖复位,恢复寰枢关节正常序列,术后颈痛及神经症状均部分改善甚至完全恢复,均未出现脊髓损伤加重。1例一期术后出现咽部不适、饮水呛咳,4例术后有不同程度的咽部不适、异物感,2例于颅骨牵引过程中出现钉道口红肿,均行对症处理后治愈。治疗过程中未出现肺部感染、压疮、下肢静脉血栓形成、切口感染等。15例患者均获随访,随访时间24～36个月,平均28.6个月。植骨均获骨性融合,融合时间3～5个月,平均3.6个月。末次随访时VAS评分为0～2分,平均0.5分;JOA评分为13～17分,平均15.9分。末次随访时复查颈椎X线片及三维CT均未见脱位复发及其他异常征象。结论采用一期经颈前咽后入路前方松解、二期经后路植骨融合内固定术治疗难复性寰枢关节脱位可达到解剖复位,是一种可供选择的术式。Objective To discuss the effectiveness of atlantoaxial joint release through anterior retrophayngeal approach and staged posterior reduction fixation and fusion for irreducible atlantoaxial dislocation（IAAD）.Methods Fifteen patients with IAAD（9 males, 6 females）, aged 14-53 years（mean, 31.4 years） were included in the study. The disease duration was 3 months to 17 years（mean, 5.7 years）. IAAD was attributed to trauma in 13 cases, and2 cases were caused by congenital odontoid disconnection. Preoperative imaging examination showed atlantoaxial dislocation and could not be reset automatically in functional position. The preoperative visual analogue scale（VAS） score was 3-7（mean, 4.1）, and the preoperative Japanese Orthopaedic Association（JOA） score was 10-17（mean, 13.8）. All patients received atlantoaxial joint release through anterior retrophayngeal approach and staged posterior fixation and fusion. Results Anatomical reduction was achieved in all 15 patients, and the alignment of atlantoaxial joints was restored. After operation, the neck pain and neurological symptom were partially or fully improved in all patients, without deterioration of neurological function. One patient developed pharyngeal discomfort and cough after one-stage operation,4 patients developed pharyngeal discomfort and foreign body sensation after operation, and 2 patients developed pin-path lipstick swelling during skull traction. All patients were cured by symptomatic treatment. No pulmonary infection,pressure ulcers, venous thrombosis, and incision infection was found during the treatment. All 15 patients were followed up 24-36 months, with an average of 28.6 months. Bony fusion was achieved in all patients, and the fusion time was 3-5 months, with an average of 3.6 months. At last follow-up, the VAS score was 0-2（mean, 0.5） and the JOA score was 13-17（mean, 15.9）. There was no dislocation, recurrence, or other abnormal sign in the cervical X-ray films and threedimensional CT. Conclusion Anatomical red

关 键 词：寰枢关节脱位 颈前咽后入路 前路松解 后路融合术 

分 类 号：R687.3[医药卫生—骨科学]