后路关节间撑开复位术治疗颅底畸形合并陈旧性寰枢椎旋转脱位的临床效果  

Posterior atlantoaxial intra-articular fusion technique for the treatment of atlantoaxial rotatory fixation with basilar malformation

作　　者：张博彦 戚茂杨 孟洪锋 辛宗 关健 段婉茹[1] 菅凤增[1] 陈赞[1] ZHANG Boyan;QI Maoyang;MENG Hongfeng;XIN Zong;GUAN Jian;DUAN Wanru;JIAN Fengzeng;CHEN Zan(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Spine Center,China International Neuroscience Institute(CHINA-INI),Lab of Spinal Cord Injury and Functional Reconstruction,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,中国国际神经科学研究所脊柱中心,首都医科大学宣武医院脊髓损伤与功能重建实验室,北京100053

出　　处：《中华骨与关节外科杂志》2023年第8期693-698,共6页Chinese Journal of Bone and Joint Surgery

基　　金：中央高水平医院临床科研业务费资助(2022-PUMCH-D-004);北京市医院管理中心临床医学发展专项经费资助(XMLX202138);北京市医院管理局青年人才培养“青苗”计划(QML20210801);中国医学科学院医学与健康科技创新工程项目(CIFMS#2021-1-I2M-025);北京市自然科学基金-海淀原始创新联合基金资助项目(L212039);首都临床特色诊疗技术研究及转化应用(Z221100007422019)。

摘　　要：目的:探讨采用后路关节间复位融合技术治疗寰枢椎旋转脱位的临床效果。方法:回顾性分析2020年11月至2022年10月收治的7例寰枢椎旋转脱位患者的临床资料。男4例,女3例,年龄6~54岁,平均(28.1±17.8)岁。其中2例曾行后路复位内固定术后复位丢失。所有患者行后入路寰枢椎关节间撑开复位内固定术,术后对全部病例进行复查及临床随访,分析术后影像学及症状学指标的改善情况。结果:全部7例患者均顺利完成手术。术后3 d CT提示C1-C2夹角、寰齿间距(ADI)、齿状凸尖至钱氏线距离(DCL)、寰齿后间距,即椎管直径(p-ADI)均较术前改善,差异有统计学意义(P<0.05)。术后6个月随访时日本骨科协会(JOA)腰椎评分较术前显著提高,差异有统计学意义(P<0.05)。所有患者中未见植入物失败,融合器塌陷、移位及复位丢失,感染等并发症发生。结论:寰枢椎旋转脱位可通过后路寰枢椎关节间撑开复位融合术达到良好复位。Objective:To evaluate the clinical effect of posterior atlantoaxial intra-articular fusion technique on atlantoaxial rotatory fixation.Methods:Clinical data of 7 patients with atlantoaxial rotatory fixation treated from November 2020 to Octobor 2022 were retrospectively analyzed.There were 4 males and 3 female with a mean age of(28.1±17.8)years(range,6-54 years).Among them,2 patients had undergone posterior reduction and internal fixation and lost the reduction.Posterior atlantoaxial intra-articular fusion was performed in all the patients,and the follow-up was conducted in all of them to evaluate clinical outcomes by imaging and symptomatic indicators.Results:The 7 patients underwent surgery successfully.The C1-C2 angle,atlantoaxial distance(ADI),the distance of odontoid tip above Chamberlain line(DCL),posterior atlantoaxial distance(the diameter of the spinal canal,p-ADI),and JOA score were all improved poostoperatively(P<0.05).No implant failure,loss of repositioning,spacer subsidence or infection was observed.Conclusions:Rotational atlantoaxial fixation can be well repositioned by posterior atlantoaxial intra-articular fusion technique.

关 键 词：寰枢关节 脱位 后入路手术 脊柱融合术 

分 类 号：R682.1[医药卫生—骨科学]