作　　者： (屈巍）; (胡慧敏）; (宋宗让）; (郝定均）; (吴起宁）; (刘继军）; (王欣文）;

机构地区： 西安交通大学附属红会医院脊柱外科,西安710054

出　　处： 《中国现代手术学杂志》 2017年第3期201-205,共5页

摘　　要： 目的采用单纯后路松解寰枢椎弓根钉棒复位固定技术治疗难复性寰枢椎脱位,评价其可行性及疗效。方法回顾性分析2011年3月至2015年12月我科收治的28例难复性寰枢椎脱位患者的临床资料。所有患者均采用后路松解寰枢椎弓根螺钉复位固定,后于寰枢椎板间植骨融合。随访颈椎X线、CT、MRI观察复位及脊髓减压情况,测量寰枢椎管最小矢状径及CMA改善状况,观察植骨愈合情况及JOA评分。结果手术时间平均(145±37)min(115~210 min);手术平均失血量(205±65)ml(140~290 ml)。术中无脊髓、神经根及椎动脉损伤发生,所有患者寰枢椎弓根螺钉成功置入,23位患者(82%)寰枢关节完全复位,所有患者脊髓减压满意。术后随访平均25.6(12~36)个月。术后6个月所有患者植骨融合良好,随访期间未发生内固定松动断裂及脱位复发。在末次随访,JOA评分由术前平均8.6±2.2改善到14.8±1.8(P<0.0005),平均改善率为73.8%;寰枢椎管最小矢状径由术前平均(9.3±4.2)mm改善到(18.6±3.2)mm(P<0.0005)。CMA由术前平均115.2°±12.5°改善到153.6°±9.3°(P<0.05)。结论采用单纯后路松解寰枢椎弓根螺钉复位固定技术可有效治疗难复性寰枢椎脱位,临床效果满意。 Objective To explore the feasibility and efficacy of posterior realignment and reduction combined atlantoaxial pedicle screw-rod fixation for the treatment of irreducible atlantoaxial dislocation.Methods From March 2011 to December 2015,a total of 28 patients of irreducible atlantoaxial dislocation underwent posterior realignment and reduction combined atlantoaxial pedicle screw-rod fixation were treated in our department and followed up.Results The average operation time was （145 ± 37）min（115 ～210 min）;The average blood loss of the operation was （205 ±65）ml （140 ～290 ml）.No spinal cord,nerve root or vertebral artery injury occurred during operation.All the atlantoaxial pedicle screws were placed successfully.Complete reduction of atlantoaxial joint wasfound in 23 patients（82%）,and satisfying spinal decompression was found in all patients.The average follow-up was 25.6 （12～36） months.Complete bone fusion was obtained in all patients at 6 months after operation.No looseness or rupture of internal fixation or recurrent dislocation was observed.At the final day of the follow-up,the mean JOA score was improved from 8.6 ±2.2 pre-operation to 14.8 ± 1.8 post-operation（P 〈0.0005）,and the improvement rate was 73.8%,and the mean minimum sagittal diameter of atlantoaxial canal was improved from （9.3 ± 4.2） mm to （18.6 ± 3.2） mm （P 〈 0.0005）.The mean CMA was improved from 115.2 ° ± 12.5 ° to 153.6° ± 9.3 ° （P 〈 0.0005）.Conclusion Posterior realignment of irreducible atlantoaxial dislocation with atlantoaxial pedicle screw-rod fixation is effective with satisfactory clinical results.

关 键 词： 寰枢椎脱位 手术入路 后路 内固定器