颈前路寰齿关节成形治疗伴寰齿关节骨性异常的难复性寰枢椎脱位  

Cervical anterior approach atlantodentoplasty for the treatment of irreducible atlantoaxial dislocation complicated with bony abnormality of atlanto-dental joint

作　　者：邵佳 高坤[1] 毛克政 张修儒[1] 高延征[1] Shao Jia;Gao Kun;Mao Kezheng;Zhang Xiuru;Gao Yanzheng(Department of Spinal Surgery,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院脊柱脊髓外科,郑州450003

出　　处：《中华骨科杂志》2022年第23期1554-1562,共9页Chinese Journal of Orthopaedics

基　　金：河南省自然科学基金(202300410400)。

摘　　要：目的探讨颈前路寰齿关节成形治疗伴寰齿关节骨性异常难复性寰枢椎脱位的临床疗效。方法回顾性分析于河南省人民医院收治伴寰齿关节骨性异常难复性寰枢椎脱位31例患者的临床资料,男7例、女24例,年龄(49.0±12.0)岁(范围23~74岁)。21例寰齿关节骨关节炎患者行单纯寰齿关节骨赘切除成形术,5例前结节肥大患者及5例前结节肥大伴寰齿关节骨关节炎患者行寰齿关节骨赘切除、前结节部分切除的寰齿关节成形术;同期行后路枕颈固定融合术。记录颈前路寰齿关节成形术及整体手术的时间和术中出血量,术前及术后1周测量寰椎前结节厚度(anterior tubercle thickness,ATT)、寰齿前间隙(atlantodental interval,ADI),术前、术后1周、3个月、12个月及末次随访时的枕骨大孔处脊髓可用空间(space available for the cord,SAC)、斜坡椎管角(clivus-canal angle,CCA)、颈髓延髓角(cervico-medullary angle,CMA)、日本骨科学会(Japanese Orthopedic Association,JOA)评分,并计算末次随访时JOA改善率,记录术后植骨融合时间,观察并发症发生情况。结果31例患者均获得随访,随访时间为(34.5±13.8)个月(范围12~60个月)。颈前路寰齿关节成形的手术时间为(120.9±15.9)min,整体手术时间为(315.1±31.4)min;前路手术出血量为(101.2±31.2)ml,整体手术出血量为(372.7±56.0)ml。10例行寰椎前结节部分切除的患者术后ATT为(7.4±1.6)mm,较术前的(10.8±1.5)mm减小,差异有统计学意义(t=4.94,P=0.001)。31例患者术后1周ADI为(0.9±1.2)mm,较术前的(8.3±2.2)mm减小,差异有统计学意义(t=17.91,P<0.001)。术前SAC为(10.4±2.8)mm,术后1周恢复至(19.2±3.6)mm,末次随访时为(19.4±3.7)mm(F=41.31,P<0.001);术前CCA为119.4°±17.9°,术后1周增加至142.6°±13.0°,末次随访时为141.6°±12.2°(F=35.86,P<0.001);术前CMA为121.7°±14.1°,术后1周增加至148.9°±9.4°,末次随访时为149.4°±9.0°(F=52.07,P<0.001)。术前JOA评分为(12.0Objective To evaluate the clinical efficacy of cervical anterior approach atlantodentoplasty for the treatment of irreducible atlantoaxial dislocation complicated with bony abnormality of atlanto-dental joint.Methods Retrospective analysis was conducted to study the clinical data of 31 patients with irreducible atlantoaxial dislocation complicated with bony abnormality of atlanto-dental joint,including 7 males and 24 females;age ranged from 23 to 74 years,with an average of 49.0±12.0 years.All patients underwent cervical anterior approach soft tissue release,atlantodentoplasty and one-stage posterior occipito-cervical fixation and fusion.Twenty-one patients with atlantodental osteoarthritis underwent simplex atlantodental osteophyte resection,5 patients with anterior tubercle hypertrophy of atlas and 5 patients with anterior tubercle hypertrophy of atlas and atlantodental osteoarthritis underwent atlantodental osteophyte resection and partial anterior tubercle resection.The operation time and blood loss of anterior procedure and total procedure were recorded.The anterior tubercle thickness(ATT),the atlantodental interval(ADI)were recorded before and 1 week after the operation.The available space of the cord(SAC),clivus-canal angle(CCA),cervicomedullaryangle(CMA),and the Japanese Orthopaedic Association(JOA)scores were recorded before the operation,1 week,3 months and 12 months after the operation,and at the last follow-up.The JOA improvement rate at the last follow-up was calculated,the time of postoperative bone graft fusion was recorded,and the complications were observed.Results All patients were followed up for 12-60 months,with an average of 34.5±13.8 months.The operation time of anterior cervical atlantodentoplasty was 120.9±15.9 min,and the overall operation time was 315.1±31.4 min;The blood loss of anterior procedure was 101.2±31.2 ml,and that of overall procedure was 372.7±56.0 ml.The one week postoperative ATT(7.4±1.6 mm)of patients with anterior tubercle partial resection of atlas was lower than

关 键 词：寰枢关节 脱位 骨关节炎 脊柱 肥大 截骨术 脊柱融合术 

分 类 号：R687.4[医药卫生—骨科学]