复杂寰枢椎脱位的充分认识和积极处理

Knowing and actively treating of complicated atlantoaxial dislocation

目的分析复杂寰枢椎脱位的复杂因素并探讨其解决方案。方法回顾性分析68例复杂寰枢椎脱位的临床特点、复杂因素,分别采取Ⅲ型经口咽寰枢椎复位钢板(TARP-Ⅲ)内固定术、深部磨削减压技术、计算机辅助设计与快速成型(CAD-RP)技术个性化手术及经口扩大入路技术等相应的特殊治疗措施。结果随访平均28个月,60例获解剖复位,8例接近解剖复位,受压颈髓获充分减压,脊髓减压改善率87.2%,神经功能改善率76.6%。发生颅内感染3例。结论针对性地分别采用以上4项技术能使一些复杂的寰枢椎脱位得到有效治疗。

Objective To explore clinic characteristic and treatment of complicated atlantoaxial dislocation.Methods Characteristic and complicated factors of 68 patients with complicated atlantoaxial dislocation that failed in treatment with conventional therapy in the last 4 years were reviewed.According to the complicated factors different treatments mainly including transoralpharyngeal atlantoaxial reduction plate-Ⅲ（TARP-Ⅲ） operation,decompression procedure by grinding at deep part,individualized computer aided design-rapid prototyping（CAD-RP） operation or improve the approach were used.Results The average follow-up was 28 months long.In 68 cases,atlanto-axial joint achieved completely anatomical immediate reduction in 60 cases,nearly anatomical immediate reduction in 8 cases.All cases spinal cords were sufficiently decompressed with 87.2% average decompression rate and 76.6% average improvement rate of nerve function.Two cases suffered intracranial infection.Conclusion Some complicated atlantoaxial dislocation can be effectively treated by knowing the complicated factors and mastering above four technologies.