后路寰枢椎侧块关节cage植骨融合内固定术治疗难复性寰枢椎脱位疗效初探  

Preliminary observation of the clinical efficacy of posterior atlantoaxial lateral mass joint cage graft fusion and internal fixation in the treatment of irreducible atlantoaxial dislocation

作　　者：房跃坤 杨智麟 李昊天 王伟舟[1] 熊云宇 毕航川 刘源[1] 王兵[1] 董俊杰[1] 杨晋[1] 龚志强[1] 陈凌强[1] FANG Yuekun;YANG Zhilin;LI Haotian(Department of Orthopaedics,the First Affiliated Hospital of Kunming Medical University,Kunming,650032,China)

机构地区：[1]昆明医科大学第一附属医院骨科,昆明市650032

出　　处：《中国脊柱脊髓杂志》2024年第3期255-265,共11页Chinese Journal of Spine and Spinal Cord

基　　金：国家自然科学基金项目(编号:81860093,81660215);云南省科技厅-昆明医科大学应用基础研究联合专项杰出青年培育项目(编号:202101AY070001-031)。

摘　　要：目的:探讨后路寰枢椎侧块关节cage植骨融合内固定术治疗难复性寰枢椎脱位的临床疗效,并与经口咽松解后路复位固定融合术进行疗效对比。方法:回顾性分析2018年1月~2022年8月我科采用后路寰枢椎侧块关节cage植骨融合内固定术(23例,cage组)与经口咽松解后路复位固定融合术(25例,对照组)治疗的难复性寰枢椎脱位患者的临床资料,cage组男8例,女15例,年龄9~79岁(48.35±14.38岁);对照组男6例,女19例,年龄21~69岁(47.84±13.51岁)。记录两组患者手术时间、术中出血量、住院时间及并发症情况,术前、术后及末次随访时使用JOA评分评估患者神经功能状态,测量术前、术后及末次随访时的寰齿间距(atlantodental interval,ADI)、齿状突顶点距离Chamberlain线的垂直距离(vertical distance from odon to idprocess to Chamberlain′s line,DOCL)、延髓颈髓角(cervicomedullary angle,CMA)、斜坡枢椎角(clivus-axial angle,CAA),评估寰枢椎复位情况。评估侧块关节cage及后方植骨融合情况。结果:所有患者内固定位置良好,减压充分复位满意,症状均明显缓解,未出现椎动脉损伤和脊髓损伤加重。cage组手术时间133.04±34.04min、术中出血量119.13±54.77mL、住院时间14.74±6.10d,均明显短于或少于对照组(253.20±53.98min、181.20±45.40mL、23.96±5.47d)。cage组术前JOA、ADI、DOCL、CMA、CAA分别为6.33±1.13分、7.31±3.05mm、9.47±3.32mm、122.89°±12.58°、122.02°±12.50°,术后分别为13.04±2.17分、2.18±0.67mm、0.89±1.00mm、148.81°±5.43°、146.70°±9.32°,末次随访时分别为14.89±1.17分、2.09±0.69mm、0.83±0.86mm、149.10°±5.11°、146.89°±8.95°;对照组术前JOA、ADI、DOCL、CMA、CAA分别为6.76±1.21分、7.70±0.97mm、10.56±1.99mm、121.53°±4.87°、123.77°±8.95°,术后分别为13.26±1.32分、1.89±0.50mm、1.13±1.08mm、151.40°±6.15°、149.86°±5.58°,末次随访时分别为15.02±0.88分、1.87±0.44mm、0.87±1.39mm、149.48Objectives: To investigate the clinical efficacy of posterior atlantoaxial lateral mass joint cage graft fusion and internal fixation for the treatment of irreducible atlantoaxial dislocation(IAAD) through comparing with the transoral pharyngeal release and posterior reduction, fixation and fusion procedure. Methods: The clinical data of patients with IAAD treated with posterior atlantoaxial lateral mass joint cage graft fusion and internal fixation(23 cases, cage group) and transoral pharyngeal release and posterior reduction, fixation and fusion(25 cases, control group) in our department from January 2018 to August 2022 were retrospectively analyzed. There were 8 males and 15 females in the cage group, aged 9-79(48.35±14.38) years old, while 6 males and 19 females were in the control group, who aged 21-69(47.84±13.51) years old. The operative time, intraoperative bleeding, length of hospital stay and complications were recorded. Japanese Orthopaedic Association(JOA) score was used to evaluate nerve functions, and atlantodental interval(ADI), vertical distance from odontoid process to Chamberlain′s line(DOCL), cervicomedullary angle(CMA), and clivus-axial angle(CAA) were measured to evaluate the reduction of atlantoaxial dislocation preoperatively, postoperatively and at final follow-up. The conditions of lateral mass joint cage and posterior bone graft fusion were also assessed. Results: All the patients had good positions of internal fixation, adequate decompressions and satisfactory reductions, and all symptoms were significantly relieved without vertebral artery injury and aggravation of spinal cord injury. The operative time, intraoperative bleeding and length of hospital stay in the cage group were 133.04±34.04min, 119.13±54.77mL and 14.74±6.10d, which were significantly less or shorter than those in the control group(253.20±53.98min, 181.20±45.40mL, 23.96±5.47d), respectively. The preoperative JOA, ADI, DOCL, CMA, CAA of the cage group were 6.33±1.13 points, 7.31±3.05mm, 9.47±3.32mm, 122.89°

关 键 词：寰枢椎脱位 后路 侧块关节 植骨融合 融合器 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]