寰枢关节脱位伴齿状突后假瘤的手术治疗效果分析  

Outcomes of surgical treatment for retro-odontoid pseudotumor with atlantoaxial dislocation

作　　者：邱锴[1] 余斌[1] 陈煜 丁大领[1] 李恩[1] 庞长河[1] 张风江[1] Qiu Kai;Yu Bin;Chen Yu;Ding Daling;Li En;Pang Changhe;Zhang Fengjiang(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450052

出　　处：《中华神经外科杂志》2025年第3期275-279,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨寰枢关节脱位伴齿状突后假瘤(ROP)患者的手术方式和临床疗效。方法回顾性分析2019年8月至2024年7月在郑州大学第一附属医院神经外科接受手术治疗的11例寰枢关节脱位伴ROP患者的临床资料。4例混合型和2例囊性ROP患者接受后路融合术+假瘤切除术(硬膜内入路)+椎管减压术,3例实性ROP和1例混合型ROP患者接受后路融合术+椎管减压术,1例实性ROP患者接受单纯后路融合术。术后定期行影像学随访,评估ROP的体积变化和椎管减压效果。临床随访采用日本骨科协会评分评估手术疗效。结果11例患者中,2例囊性ROP切除及减压效果满意,4例混合型ROP切除困难,未有效减压;4例接受后路融合术+椎管减压术、1例接受单纯后路融合术的患者均顺利完成手术。所有患者均接受随访,随访时间为(8.6±6.0)个月(3~24个月)。ROP的最大径[M(Q_(1),Q_(3))]由术前的10.1(6.8,13.3)mm降至术后的2.3(1.8,5.4)mm(Z=-2.94,P=0.003),日本骨科协会评分[M(Q_(1),Q_(3))]由术前的12(8,14)分提升至术后的15(13,16)分(Z=-2.84,P=0.005)。1例患者术后出现短暂性吞咽困难,经康复治疗后痊愈。其余10例患者术后未见明显并发症。结论对于寰枢关节脱位伴ROP的患者,通过后路融合术联合ROP切除术、椎管减压术治疗可获得满意的影像及临床预后。ObjectiveTo investigate the surgical approach and clinical efficacy in patients with atlantoaxial dislocation(AAD)accompanied by retro-odontoid pseudotumor(ROP).MethodsA retrospective analysis was conducted on the clinical data of 11 patients with AAD accompanied by ROP who underwent surgical treatment in the Department of Neurosurgery at the First Affiliated Hospital of Zhengzhou University between August 2019 and July 2024.Among them,4 mixed-type and 2 cystic patients underwent posterior fusion+pseudotumor resection(intradural approach)+spinal canal decompression;3 solid-type and 1 mixed-type patients received posterior fusion+spinal canal decompression;and 1 solid-type patient underwent posterior fusion only.Postoperative imaging and clinical follow-ups were conducted,with surgical outcomes evaluated using the Japanese Orthopaedic Association(JOA)score.ResultsAmong the 11 patients,2 with cystic ROP had successful resection and decompression.In 4 cases of mixed-type ROP,resection was difficult and ineffective for decompression.The 4 patients who received posterior fusion plus laminectomy and those who had posterior fusion only completed surgery smoothly.All patients underwent both imaging and clinical follow-up.The postoperative follow-up period ranged from 3 to 24 months,with an average of 8.6±6.0 months.The maximum diameter[M(Q_(1),Q_(3))]of the pseudotumor reduced from 10.1(6.8,13.3)mm preoperatively to 2.3(1.8,5.4)mm postoperatively(Z=-2.94,P=0.003),while the JOA score improved from 12(8,14)points preoperatively to 15(13,16)points postoperatively(Z=-2.84,P=0.005).One patient experienced postoperative dysphagia,which resolved after rehabilitation.No postoperative complications occurred in the remaining 10 patients.ConclusionFor patients with AAD accompanied by ROP,posterior fusion combined with pseudotumor resection and spinal canal decompression can lead to satisfactory imaging and clinical outcomes.

关 键 词：关节脱位 寰枢关节 治疗结果 齿状突后假瘤 后路融合术 C 1椎板切除减压术 

分 类 号：R687.3[医药卫生—骨科学]