显微镜下行寰枢椎侧块松解术治疗寰枢椎脱位的临床效果  

Clinical effect of atlantoaxial lateral mass release under microscope for atlantoaxial dislocation

作　　者：高凯 刘俊[1] 黄南勇 姚浩群[1] GAO Kai;LIU Jun;HUANG Nanyong;YAO Haoqun(Department of Orthopaedics,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院骨科医院骨科,南昌330006

出　　处：《中华骨与关节外科杂志》2025年第2期129-134,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:探讨显微镜下行寰枢椎侧块松解术治疗寰枢椎脱位的临床效果。方法:回顾性选取2018年1月至2023年4月南昌大学第一附属医院收治的48例寰枢椎脱位患者作为研究对象,根据手术方法分为显微镜组(26例,显微镜下行寰枢椎侧块松解术)和非显微镜组(22例,传统寰枢椎侧块松解术)。记录两组患者的围手术期指标,比较两组患者术前和术后12个月颈椎矢状位参数、疼痛程度、功能状态及手术治疗效果。结果:两组患者术中均未发生并发症。显微镜组患者术中出血量少于非显微镜组,术后C2神经根麻痹发生率低于非显微镜组,差异均有统计学意义(P均<0.05)。术后12个月,显微镜组患者斜坡椎管角(CCA)、延髓脊髓角(CMA)均大于术前,差异均有统计学意义(P均<0.05)。术后12个月,两组患者疼痛视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)均低于本组术前,日本骨科协会(JOA)评分均高于本组术前,差异均有统计学意义(P均<0.05)。结论:在治疗寰枢椎脱位患者时,与传统的寰枢椎侧块松解术相比,显微镜下行寰枢椎侧块松解术的术中出血量更少、术后C2神经根麻痹发生率更低,并且能够有效改善患者的颈功能状态、减轻疼痛。Objective:To explore the clinical effect of microscopic atlantoaxial block release for atlantoaxial dislocation.Methods:Retrospectively,48 patients admitted to the First Affiliated Hospital of Nanchang University from January 2018 to April 2023 were selected as the study objects and divided into microscopic group(26 cases,microscopic descending atlantoaxial mass release)and nonmicroscopic group(22 cases,traditional atlantoaxial mass release)according to the surgical method.Perioperative indicators were recorded in both groups,comparing cervical sagittal parameters,pain level,functional status and surgical treatment effect of the two groups before and 12 months after surgery.Results:There were no intraoperative complications in both groups.The amount of intraoperative blood loss in patients in the microscope group was less than that in the non-microscopic group,and the incidence of postoperative C2 nerve root paralysis in the microscope group was lower than that in the non-microscopic group,and the difference was statistically significant(P<0.05).At 12 months after surgery,CCA and CMA in the microscope group were larger than preoperative,and the difference was significant(P<0.05).At 12 months after surgery,the pain VAS score and NDI were lower than the JOA score were higher than the preoperative group,and the difference was statistically significant(P<0.05).Conclusions:In the treatment of patients with atlantoaxial dislocation,compared with the traditional atlantoaxial lateral mass release,the intraoperative blood loss is less and the incidence of postoperative C2 nerve root palsy is lower when performing the atlantoaxial lateral mass release under a microscope.It can also effectively improve the patient's cervical function status and alleviate pain.

关 键 词：显微镜 寰枢椎脱位 寰枢椎侧块松解 后路复位固定术 

分 类 号：R687.3[医药卫生—骨科学]