寰枢关节脱位的综合分型及临床应用

The synthetic typing and its clinical application in atlantoaxial dislocation

目的探讨寰枢关节脱位的综合分型及治疗策略。方法在病因分型的基础上结合Fielding影像学分型和临床分型拟定和采用了寰枢关节脱位的综合分型，简称PIR分型。根据此综合分型系统对93例寰枢关节脱位患者进行分型和治疗。结果9例齿突Ⅱ型骨折采用中空螺钉直接固定，术后3个月愈合，颈椎功能轻度受限；1例仍有FieldingⅠ度移位。34例经口咽前路寰枢椎复位钢板内固定术（TARP），其中32例术后3个月关节复位融合良好，2例螺钉松动再脱位，经翻修手术愈合。4例行前和（或）后路减压术后神经症状改善，但未能复位，其中1例发生颅内感染。结论PIR分型表达了寰枢关节脱位病因、影像学和力学稳定性三个方面的因素和特征，对临床治疗具有指导意义。TARP手术和后路寰枢椎弓根钉杆固定是治疗寰枢椎脱位的主要手段。

Objective To evaluate the synthetic typing and the treatment strategy for atlantoaxial dislocation. Methods The synthetic typing of atlantoaxial dislocation was worked out on the base of pathogenesis typing, Fielding imaging typing, and clinical typing, named PIR typing system （ Pathogenesis, Imaging, and Reduction）. Ninety-three patients with atlantoaxial dislocation were treated according to this typing system. Results Nine cases of type-Ⅱ dens fracture were treated with canulated screw fixation. Bone union was accomplished at the follow-up of three months in all the patients, only with slight limitation of cervical motion. Unretrieved Fielding Ⅰ -degree dislocation was found in one case. Among the thirty-four patients treated with transorepharyngeal atlantoaxial reduction plate system（TARP） ,32 obtained complete atlantoaxial reduction and fusion three months after operation. Atlantoaxial dislocation recurred in the other two cases because of screw loosening and the problem was solved through revision operations. Four patients in unreducible type underwent anterior and/or posterior decompression. Their neurological symptoms improved after operation but their atlantoaxial joints remained dislocated, and one case complicated with intracranial infection. Conclusions Via the synthetic PIR typing system, atlantoaxial dislocation can be better classified according to its pathogenesis, imaging manifestation and mechanic stability. This system can also be served as a guide for clinical treatment. Anterior TARP operation and posterior atlantoaxial transpedical screw-rod fixation are the main methods for the treatment of atlantoaxial dislocation.