外伤性寰椎横韧带断裂的治疗策略

Treatment strategy of traumatic disruption of transverse atlantal ligament

目的探讨外伤性寰椎横韧带断裂治疗策略。方法回顾性分析一组24例寰椎横韧带断裂病例,其中单纯横韧带断裂15例,合并有寰椎骨折7例,合并齿状突骨折2例。急性损伤20例,陈旧性损伤4例。手术行寰枢椎融合术14例,枕颈融合6例,非手术治疗3例,入院后当天死亡1例。结果23例获得随访,平均随访时间为46个月。20例手术治疗患者中15例完全恢复正常,3例仍有局部症状,2例颈脊髓神经损害改善,无术后神经损害加重病例。3例接受非手术治疗患者中有2例出现寰枢椎不稳及迟发性脊髓损害。结论寰椎横韧带是维持寰枢椎正常解剖关系不可或缺的重要结构,横韧带断裂必然导致寰枢椎不稳定。无论是急性或陈旧性损伤,一旦诊断明确即应在早期行寰枢椎或枕颈融合术。

Objective To discuss surgical treatment strategy of traumatic disruption of transverse atlantal ligament. Methods 24 cases with traumatic disruption of transverse atlantal ligament are retrospectively analyzed. 15 cases were simple dismption of transverse atlantal ligament, the other 9 cases were disruption of transverse atlantal ligament combined with either atlas or odontoid bone fracture. Twenty cases were acute injury and 4 cases were old injury. Atlanto-axial or occipito-cervical fusion was performed in 20 cases, and 3 cases were treated nonoperatively. One died in the day admitted to hospital. Results All the 23 cases were with a mean follow-up of 46 months. Of the 20 cases treated surgically, 15 cases recovered completely, 3 casos still had some local symptoms, 2 cases partially improved in neural functions. Conclusion Transverse atlantal ligament is of great importance in the atlantoaxial complex. Disruption of transverse atlantal ligament can result in atlantoaxial instability. Whether acute or old, atlanto-axial or occipito-cervical fusion must be performed when the diagnosis was established.