难以复位的寰枢椎脱位的手术治疗方法研究  

Surgical treatment strategy for difficult-reducible atlantoaxial dislocation

作　　者：段婉茹[1] 张博彦 戚茂杨 辛宗 杜越崎 张璨[1] 刘振磊 晏怡[2] 陆云涛[3] 菅凤增[1] 陈赞[1] Duan Wanru;Zhang Boyan;Qi Maoyang;Xin Zong;Du Yueqi;Zhang Can;Liu Zhenlei;Yan Yi;Lu Yuntao;Jian Fengzeng;Chen Zan(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Neurosurgery,Nanfang Hospital,Southern Medical University,Guangzhou 102413,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053 [2]重庆医科大学附属一院神经外科,重庆400016 [3]南方医科大学南方医院神经外科,广州102413

出　　处：《中华医学杂志》2022年第43期3443-3448,共6页National Medical Journal of China

摘　　要：目的探讨难以复位的寰枢椎脱位的手术治疗方法。方法回顾性分析2018年1月至2019年2月于首都医科大学宣武医院神经外科接受手术治疗的82例寰枢椎脱位患者的临床资料。其中男32例,女50例,年龄(41.8±12.9)岁。用一期后路撑开、融合器置入的方式治疗绝大部分(n=80)难以复位的寰枢椎脱位,少数病例(n=2)行腹侧减压。对全部病例进行临床随访,分析术后临床症状和影像学指标改善情况。结果共80例(97.6%)进行了一期寰枢关节撑开、融合器置入,其中4例伴有侧方关节骨性融合,以骨凿切断;2例(2.4%)寰齿关节骨性融合的患者进行了经口齿状突切除。所有患者均获随访,随访时间为(18.6±7.3)个月。术后CT随访发现60例患者(75.0%)寰齿间距(ADI)恢复正常。患者术后ADI较术前降低,差异有统计学意义[(2.1±1.4)mm比(5.0±1.5)mm,P<0.05];术后齿状突距离钱氏线的垂直距离较术前下移,差异有统计学意义[(3.9±3.8)mm比(10.2±5.2)mm,P<0.05];术后6个月日本骨科协会(JOA)评分较术前提高,差异有统计学意义(13.7±1.5比11.2±1.7,P<0.05)。75例(93.8%)患者在术后1年随访即形成寰枢关节间骨性融合。结论难复性寰枢椎脱位绝大部分可通过后路一期寰枢关节撑开、融合器置入手术达到良好的复位。Objective To discuss the surgical strategy for difficult-reducible atlantoaxial dislocation.Methods Clinical data of 82 patients with difficult-reducible atlantoaxial dislocation underwent surgical treatment in the Department of Neurosurgery,Xuanwu Hospital from January 2018 to February 2019 were retrospectively reviewed.Total of 32 men and 50 women were included,with a mean age of(41.8±12.9)years.Most cases(n=80)were treated with one-staged posterior atlantoaxial joint distraction and cage implantation,a few(n=2)underwent ventral decompression.All cases were followed up,postoperative improvement of clinical symptoms and radiology parameters were analyzed.Results Of the patients,80 cases(97.6%)received one-staged posterior atlantoaxial joint distraction and cage implantation;lateral facet joint bony fusion was found in 4 patients and was cut off with an osteotome.Transoral odontoidectomy was performed in 2 cases(2.4%)with fused atlanto-odontoid joint.All the patients were followed-up for(18.6±7.3)months.Postoperative CT showed complete reduction of ADI was achieved in 60 patients(75.0%).The ADI decreased significantly after the operation[(2.1±1.4)mm vs(5.0±1.5)mm,P<0.05].The postoperative vertical distance between odontoid process and the Chamberlain line decreased significantly when compared with that before the operation[(3.9±3.8)mm vs(10.2±5.2)mm,P<0.05].The mean JOA score at 6 months post operation improved significantly than that before the operation(13.7±1.5 vs 11.2±1.7,P<0.05).Seventy-five patients(93.8%)had atlantoaxial intra-articular bony fusion at 1 year follow-up.Conclusion Most difficult-reducible atlantoaxial dislocations can be managed well by posterior one-staged atlantoaxial joint distraction and Cage implantation.

关 键 词：寰枢关节 寰枢椎脱位 手术策略 复位 减压 

分 类 号：R687.3[医药卫生—骨科学]