游离齿状突并发寰枢关节脱位的治疗策略及疗效分析  

Treatment strategy and curative effect analysis of os odontoideum complicated with atlantoaxial joint dislocation

作　　者：胡旭栋[1] 蒋伟宇[1] 陈云琳[1] 许楠健[1] 阮超越 马维虎[1] HU Xu-dong;JIANG Wei-yu;CHEN Yun-lin;XU Nan-jian;RUAN Chao-yue;MA Wei-hu(Department of Spine Surgery,Zhejiang Ningbo No.6 Hospital,Ningbo 315040,Zhejiang,China)

机构地区：[1]宁波市第六医院脊柱外科,浙江宁波315040

出　　处：《中国骨伤》2021年第4期321-327,共7页China Journal of Orthopaedics and Traumatology

基　　金：浙江省自然科学基金(编号:LY18H060007)。

摘　　要：目的:探讨游离齿状突并发寰枢关节脱位的治疗策略并观察其临床疗效。方法:回顾性分析2006年1月至2015年1月手术治疗的17例齿状突游离小骨并发寰枢关节脱位患者的相关资料,其中男7例,女10例;年龄17~53(43.1±11.3)岁;病程3~27(10.2±6.9)个月。所有患者术前予颅骨牵引,14例可复性脱位患者中12例行后路寰枢椎钉棒固定融合术,2例合并寰枕畸形患者行后路枕颈固定融合术,3例难复性脱位患者行前路经口咽松解联合后路寰枢椎钉棒固定融合术。记录手术时间、术中出血量及围手术期并发症;通过视觉模拟评分法(visual analogue scale,VAS)和日本骨科协会(Japanese Orthopaedic Association,JOA)评分分别评价患者手术前后枕颈部疼痛及神经功能变化;通过CT扫描评价术后寰枢关节融合率。结果:后路固定融合手术时间为86~170(92.2±27.5)min,术中出血量为200~350(250.7±65.2)ml,没有椎动脉及脊髓损伤患者。寰枢椎固定融合术中1例C2椎板螺钉固定的患者术后复位丢失,再次行前路松解并最终行枕颈融合术。所有患者获得随访,时间15~58(32.0±12.2)个月。末次随访时患者枕颈部疼痛VAS评分由术前的4.2±0.9降低至1.3±0.7(P<0.05);神经功能JOA评分由术前的11.2±1.2提高到16.9±0.8(P<0.05);CT扫描证实所有患者寰枢椎或枕颈融合良好,融合时间为5~9(6.7±0.6)个月。结论:手术治疗齿状突游离小骨并发寰枢关节脱位能取得满意的疗效,可改善患者神经功能,提高生活质量,手术方式需个体化选择。Objective:To explore the treatment strategy and clinical efficacy for os odontoideum complicated with atlantoaxial dislocation.Methods:The clinical data of 17 patients with os odontoideum complicated with atlantoaxial dislocation surgically treated from January 2006 to January 2015 were retrospectively analyzed,including 7 males and 10 females,aged 17 to 53(43.1±11.3)years old;course of disease was 3 to 27(10.2±6.9)months.All patients received cranial traction before operation,12 of 14 patients with reducible dislocation were treated by posterior atlantoaxial fixation and fusion,and 2 patients with atlantooccipital deformity were treated by posterior occipitocervical fixation and fusion;3 patients with irreducible alantoaxial dislocation were treated by transoral approach decompression combined with posterior atlantoaxial fixation and fusion.The operation time,intraoperative blood loss and perioperative complications were recorded.Visual analogue scale(VAS)and Japanese Orthopaedic Association(JOA)score were used to evaluate the change of neck pain and neurological function.Atlantoaxial joint fusion rate was evaluated by CT scan.Results:The operation time of posterior fixation and fusion ranged from 86 to 170(92.2±27.5)min,and the intraoperative blood loss was 200-350(250.7±65.2)ml.No vertebral artery injury and spinal cord injury were recorded.Among the patients underwent atlantoaxial fixation and fusion,1 patient with reducible dislocation fixed by C2 laminar screw lost reduction after primary operation,and received anterior release again and finally occipitocervical fusion.All patients were followed up for 15 to 58(32.0±12.2)months.VAS score was decreased from preoperative 4.2±0.9 to 1.3±0.7 at final follow-up and the JOA score was improved from preoperative 11.2±1.2 to 16.9±0.8 at final follow-up.CT scan confirmed that the atlantoaxial or occipitocervical fusion was good,and the fusion time was 5 to 9(6.7±0.6)months.Conclusion:Surgical treatment of os odontoideum complicated with atlantoaxial disloca

关 键 词：游离齿状突 颈寰椎 寰枢关节 脱位 脊柱融合术 

分 类 号：R681.5[医药卫生—骨科学]