前路松解复位后路融合治疗游离齿突继发环枢椎脱位

Ventral reduction and posterior fusion for the treatment of irreducible atlantoaxial dislocation secondary to Os odontoideum

目的:探讨经高位咽后入路前路松解、后路融合治疗游离齿突继发的难复性环枢椎脱位.方法:本组3例,均为男性,年龄17～36岁,无明显创伤史,颅骨牵引2～3周,采用高位咽后入路显露C1～3,行环枢前方松解复位,Ⅰ期后路环枢融合,Brooks法钛缆内固定.结果:3例游离齿突继发的难复性环枢椎脱位,术前颅骨牵引不能复位,经前路手术松解达到良好复位,后路环枢融合良好,内固定无松脱,无伤口感染.3例患者神经症状均明显改善.结论:经高位咽后入路行前方松解,能够复位游离齿突继发的难复性环枢椎脱位,Ⅰ期后路环枢融合可获良好的植骨融合.

Objective:To evaluate the ventral reduction through high retropharyngeal approach and posterior fusion for the treatment of irreducible atlantoaxial dislocation secondary to Os odontoideum.Method:There were 3 male patients aged 17~36 years old with irreducible atlantoaxial dislocation secondary to Os odontoideum.All patients had no remarkable cervical trauma or injury.Skull traction was used for 2 to 3 weeks.Ventral reduction was done by high retropharyngeal approach following the posterior atlantoaxial fusion with Brooks technique.Result:Reduction could not be achieved by skull traction in patients with irreducible atlantoaxial dislocation secondary to Os odontoideum.All patients got good reduction by high retropharyngeal approach and achieved posterior atlantoaxial bony fusion.There were no loosening of wire and wound infection.Neurological syndrome was improved significantly in all 3 patients.Conclusion:Patients with irreducible atlantoaxial dislocation secondary to Os odontoideum could be treated by high retropharyngeal approach following posterior C 1~2 fusion which can lead to good reduction and atlantoaxial bony fusion.