内窥镜辅助下经颈动脉三角区前路松解治疗难复性寰枢关节脱位(附12例初步报告)

Video-assisted anterior release through carotid arterial triangle for the treatment of irreducible atlantoaxial dislocation

目的:探讨内窥镜辅助下经颈动脉三角前路松解治疗难复性寰枢关节脱位的手术方法。方法:12例难复性寰枢关节脱位患者,男性4例,女性8例,年龄16～48岁,平均31.6岁;病程24～48个月,平均20个月。其中陈旧性齿状突骨折5例,齿状突不连3例,横韧带松弛症3例,齿状突短小合并寰枕融合畸形1例。术前颈脊髓功能JOA评分平均9.3分。在内窥镜辅助下经颈动脉三角区前路C1、C2松解,清除寰枢椎前方挛缩瘢痕组织(或骨)连接,颅骨牵引复位,一周后行后路内固定融合手术。结果:前路平均手术时间70min,出血量150ml。松解后11例获得解剖复位,行寰枢椎固定;1例部分复位,行枕颈融合。术后随访3～12个月,无手术切口感染和内固定失败。术后JOA评分平均15.2分,术后功能改善率76.6%。结论:内窥镜辅助下经颈动脉三角区前路松解治疗难复性寰枢关节脱位创伤小、术野清晰、安全有效。

Objective:To evaluate the clinical efficacy for the treatment of irreducible atlantoaxial dislocation by video-assisted anterior release through carotid arterial triangle.Method:Twelve patients,4 males and 8 females with the mean age 31.6 ranged from 16 to 48 years old.The interval between the onset of the symptoms and the diagnosis averaged 20 months ranging from 24 to 48 months.The type of disorders included:5 late odontoid fracture,3 osodontoideum,3 relaxation of trnsverse ligament of atlas,1 selfunion of occipital-atlantal junction with short odontoid.The preoperative JOA score was 9.3.Soft (or bone) tissue was released between C1 and C2,skull traction and posterior instrumentation after one week.Result:The average anterior operative time was 70min,blood loss was 150ml.The fixation of atlantoaxial was performed in 11 cases and occipitocervical fixation in 1 case.All patients were followed up with average 8 months ranging from 3 to 12 months,there were no infection and fixation failure.The postoperative JOA score was 15.2 which improved to 76.6%.Conclusion:Video-assisted anterior release for the treatment of irreducible atlantoaxial dislocation is a safe and effective technique with bright view and lowered risk of trauma.