后路松解复位、固定融合术治疗难复性寰枢椎脱位的远期疗效  

Long-term outcomes of posterior release and reduction for irreducible atlantoaxial dislocation

作　　者：高书涛 徐韬[1] 买尔旦·买买提[1] 郭海龙[1] 普拉提·买买提[1] 盛军[1] 邓强[1] 荀传辉[1] 梁卫东[1] 张健[1] 曹锐[1] 牙克甫·阿不力孜 任周梁 王婷[1] 盛伟斌[1] Gao Shutao;Xu Tao;Maierdan·Maimaiti;Guo Hailong;Pulati·Maimaiti;Sheng Jun;Deng Qiang;Xun Chuanhui;Liang Weidong;Zhang Jian;Cao Rui;Yakefu·Abulizi;Ren Zhouliang;Wang Ting;Sheng Weibin(Department of Spine Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urmuqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院脊柱外科,乌鲁木齐830054

出　　处：《中华骨科杂志》2022年第7期455-462,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81960235)。

摘　　要：目的探讨后路松解复位、固定融合术治疗难复性寰枢椎脱位的远期疗效。方法回顾性分析2005年1月至2016年6月接受单纯后路松解复位、固定融合术治疗难复性寰枢椎脱位患者的病历资料,男13例、女18例,年龄为(39.1±13.5)岁(范围9~72岁)。临床评价指标为颈椎功能障碍指数(neck disability index,NDI)和日本骨科协会(Japanese Orthopedic Association,JOA)评分;影像学指标为寰齿前间距(atlantodental interval,ADI)、斜坡椎管角(clivus-canal angle,CCA)、延髓脊髓角(cervico-medullary angle,CMA),以及C0~C2角和C2~C7角评估颈椎序列的改善情况。对于合并颅底凹陷症患者,测量齿突尖至Chamberlain线和Wackenheim线的距离评估垂直方向的复位情况。记录植骨融合时间及术后并发症。结果随访时间为(82.7±26.4)个月(范围61~170个月)。NDI自术前43.41%±11.60%改善至术后6个月的12.19%±6.97%,末次随访时为9.45%±7.51%(F=89.56,P<0.001)。JOA评分自术前(9.48±2.41)分提高至术后6个月的(14.71±1.42)分,末次随访时为(14.97±1.47)分(F=52.89,P<0.001)。ADI由术前(9.16±2.32)mm减小至术后6个月的(1.39±1.04)mm,末次随访时为(1.29±1.08)mm(F=189.61,P<0.001)。CCA术前为113.68°±12.67°,术后6个月恢复至143.39°±7.38°,末次随访时为142.39°±7.13°(F=67.13,P<0.001)。CMA术前为115.71°±13.69°,术后6个月增加至146.23°±10.36°,末次随访时为145.58°±10.78°(F=41.44,P<0.001)。齿突尖至Chamberlain线的距离术前为(11.15±4.35)mm,术后6个月为(2.03±2.83)mm,末次随访时为(2.15±3.02)mm(F=37.58,P<0.001)。齿突尖至Wackenheim线的距离术前为(6.81±2.57)mm,术后6个月为(-2.23±1.58)mm,末次随访时为(-2.27±1.58)mm(F=122.16,P<0.001)。C0~C2角自术前1.94°±15.82°恢复至术后6个月的14.90°±6.55°,末次随访时为14.84°±6.45°(F=11.97,P<0.001)。C2~C7角自术前27.26°±8.49°恢复至术后6个月的19.10°±5.28°,末次随访时为19.26°±5.44°(F=11.13,P<0.001)。所有患�Objective To evaluate the long-term outcomes of posterior release,reduction,fixation,and fusion for irreducible atlantoaxial dislocation(AAD).Methods Between January 2005 and June 2016,a total of 31 patients with irreducible AAD who had received posterior approach surgery were included.Among them,there were 13 males and 18 females,the average age was 39.1±13.5 years(range 9-72 years).The clinical data of the eligible individuals were collected and analyzed.Neck disability index(NDI)and Japanese Orthopaedic Association(JOA)scores were recorded to evaluate the recovery of neck and neurological functions.The atlantodental interval(ADI),clivus-canal angle(CCA),and cervico-medullary angle(CMA)were measured to evaluate the reduction of AAD.C0-C2 angle and C2-C7 angle were measured to evaluate the recovery of cervical alignment.For individuals with basilar invagination,the distances from the tip of odontoid process to Chamberlain line and Wackenheim line were measured to assess the reduction in the vertical direction.The duration of bony fusion and complications were also analyzed.Results The mean follow-up period was 82.7±26.4 months(range 61-170 months).In terms of functional scores,the NDI dropped from 43.41%±11.60%before surgery to 12.19%±6.97%at the six months follow-up,and 9.45%±7.51%at the last follow-up(F=89.56,P<0.001).The JOA increased from 9.48±2.41 points before surgery to 14.71±1.42 points at the six months follow-up,and 14.97±1.47 points at the last follow-up(F=52.89,P<0.001).Regarding the horizontal and vertical dislocations,the ADI decreased from 9.16±2.32 mm before surgery to 1.39±1.04 mm at the six months follow-up,and 1.29±1.08 mm at the last follow-up(F=189.61,P<0.001).The distance from the tip of odontoid process to Chamberlain line decreased from 11.15±4.35 mm before surgery to 2.03±2.83 mm at the six months follow-up,and 2.15±3.02 mm at the last follow-up(F=37.58,P<0.001).The distance from the tip of odontoid process to Wackenheim line reduced from 6.81±2.57 mm before surgery to-2.2

关 键 词：寰枢关节 脱位 随访研究 

分 类 号：R687.3[医药卫生—骨科学]