难复性寰枢椎脱位的经口四级松解技术  

Transoral stepped atlantoaxial release theory for irreducible atlantoaxial dislocation

作　　者：莫少东 夏虹 吴增晖 马向阳 王建华 章凯 付索超 张宇 尹庆水 艾福志 Mo Shaodong;Xia Hong;Wu Zenghui;Ma Xiangyang;Wang Jianhua;Zhang Kai;Fu Suochao;Zhang Yu;Yin Qingshui;Ai Fuzhi(Department of Orthopaedics,Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120,China;Department of Orthopaedics,General Hospital of Southern Theatre Command,Guangzhou 510010,China;Department of Spine Surgery,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China)

机构地区：[1]中山大学孙逸仙纪念医院骨外科,广州510120 [2]南部战区总医院骨科,广州510010 [3]广州医科大学第三附属医院脊柱外科,广州510150

出　　处：《中华骨科杂志》2022年第23期1542-1553,共12页Chinese Journal of Orthopaedics

基　　金：广州市科技计划项目(202201020364);广东省自然科学基金(2015A030312004)。

摘　　要：目的探讨采用不同等级经口松解技术治疗难复性寰枢椎脱位的临床疗效。方法回顾性分析2010年1月至2019年12月于南部战区总医院接受经口四级松解技术治疗297例难复性寰枢椎脱位患者的资料,男132例,女165例;年龄为(42.3±12.1)岁(范围10~63岁)。采用经口四级松解技术的例数:Ⅰ级(前部软组织松解)196例(66.0%)、Ⅱ级(360°软组织松解)54例(18.2%)、Ⅲ级(360°软组织松解+齿突切除)28例(9.4%)、Ⅳ级(截骨矫形)19例(6.4%)。临床评价指标为美国脊柱损伤协会(American spinal injury association,ASIA)运动评分及日本骨科协会(Japanese Orthopaedic Association,JOA)评分;影像学指标为斜坡椎管角(clivus-canal angle,CCA)及延髓脊髓角(cervico-medullary angle,CMA)。记录不同等级松解组的手术时间、术中出血量、植骨融合时间及术后并发症。结果随访时间为(14.8±10.2)个月(范围9~36个月)。Ⅰ~Ⅳ级松解组手术时间分别为(2.02±0.35)h、(3.00±0.36)h、(4.07±0.96)h和(5.24±0.83)h,差异有统计学意义(F=385.43,P<0.001);术中出血量为(84.08±27.21)ml、(153.61±31.36)ml、(268.93±48.94)ml和(444.21±109.51)ml,差异有统计学意义(F=582.39,P<0.001)。Ⅰ~Ⅳ级松解组术前ASIA运动评分分别为(83.85±6.68)分、(84.06±5.47)分、(84.07±5.99)分和(85.00±4.11)分,末次随访时分别为(98.34±2.38)分、(98.67±1.79)分、(98.86±1.58)分和(98.32±2.11)分,与术前的差异均有统计学意义(P<0.05);术前JOA评分分别为(11.44±1.73)分、(11.59±1.72)分、(11.61±1.47)分和(11.32±1.80)分,末次随访时分别为(16.22±1.00)分、(16.28±1.02)分、(16.14±1.04)分和(16.16±1.07)分,与术前的差异均有统计学意义(P<0.05);术前CCA分别为110.19°±8.76°、112.48°±7.66°、106.61°±6.54°和109.05°±7.79°,末次随访时分别为140.22°±8.04°、141.86°±7.04°、142.35°±8.62°和140.15°±6.49°,与术前的差异均有统计学意义(P<0.05);术前CMA分别为113.48°±9.54°、116.03°±8Objective To investigate the clinical efficacy of different grade transoral atlantoaxial release for the treatment of irreducible atlantoaxial dislocation.Methods From January 2010 to December 2019,297 patients with irreducible atlantoaxial dislocation treated by different grade releases were retrospectively analyzed,including 132 males and 165 females,aged 42.3±12.14 years(range,10-63 years).All cases were treated by different grade releases,Grade I(196,66.0%),Grade II(54,18.2%),Grade III(28,9.4%)and Grade IV(19,6.4%).The American Spinal Injury Association(ASIA)grade and Japanese Orthopedic Association(JOA)score were recorded as the clinical evaluation index.The clivus-canal angle(CCA)and cervico-medullary angle(CMA)were measured to evaluate the reduction.The surgery time,blood loss,duration of bony fusion and complications were also analyzed.Results The follow-up time was 14.8±10.2 months(range,9-36 months).The surgery time of Grade I-IV were 2.02±0.35 min,3.00±0.36 min,4.07±0.96 min and 5.24±0.83 min,respectively(F=385.43,P<0.001),blood loss was 84.08±27.21 ml,153.61±31.36 ml,268.93±48.94 ml and 444.21±109.51 ml,respectively(F=582.39,P<0.001).The preoperative ASIA motor score of Grade I-IV were 83.85±6.68,84.06±5.47,84.07±5.99 and 85.00±4.11,respectively.The last follow-up were 98.34±2.38,98.67±1.79,98.86±1.58 and 98.32±2.11,respectively,with statistically significant differences from preoperative(P<0.05).The preoperative JOA score of Grade I-IV were 11.44±1.73,11.59±1.72,11.61±1.47 and 11.32±1.80,respectively.The last follow-up were 16.22±1.00,16.28±1.02,16.14±1.04 and 16.16±1.07,respectively,with statistically significant differences from preoperative(P<0.05).The preoperative CCA of Grade I-IV were 110.19°±8.76°,112.48°±7.66°,106.61°±6.54°and 109.05°±7.79°,respectively.The last follow-up were 140.22°±8.04°,141.86°±7.04°,142.35°±8.62°and 140.15°±6.49°,respectively,with statistically significant differences from preoperative(P<0.05).The preoperative CMA of Grad

关 键 词：寰枢关节 脱位 口咽 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]