经口咽前路寰枢椎复位钢板治疗难复性寰枢椎脱位疗效观察

The 2-4 years follow-up of TARP internal fixation for the treatment of irreducible atlantoaxial dislocation

目的 探讨和评价经口咽前路寰枢椎复位钢板（transoral atlantoaxial reduction plate，TARP）内固定术治疗难复性寰枢椎脱位的中期疗效。方法2003年4月以来应用TARP手术治疗难复性寰枢椎脱位52例，观察患者的主观症状、客观体征和神经功能，进行X线摄片和MR检查，并按Symon和Lavender临床标准、JOA脊髓功能评分标准（17分法）和影像学脊髓受压减压评定标准对35例资料收集比较完整的患者，进行2-4年（平均3年）的随访，分析其中期疗效。结果35例寰枢椎脱位术后均达解剖复位或接近解剖复位，33例无钢板松动或再脱位现象。按Symon和Lavender临床标准，术前的中型8例、重型15例和特重型12例中，完全恢复16例，轻型7例，中型8例，重型4例，临床显效率80％，有效率20％；脊髓功能术后改善率平均73．5％；颈髓减压改善率平均92．6％。仅早期发生2例钢板螺钉松脱，均为老年骨质疏松患者，1例重新行TARP翻修，另1例行后路枕颈固定均获得治愈。未发生神经、血管损伤及感染并发症。结论经口咽前路寰枢椎复位钢板内固定术（TARP）是治疗难复性寰枢椎脱位很好的手术方法，具有较高的临床应用价值。

Objective To evaluate the metaphase and prosteedtive efficacy of transoral atlantoaxial reduction plate （TARP） internal fixation for the treatment of irreducible atlantoaxial dislocation. Methods Since April 2003 more than 50 patients with irreducible atlantoaxial dislocation were treated with the method of TARP internal fixation. The subjective symptoms, the objective signs, the neurological function, and the X-ray and MRI examination results of the patients were recorded. According to the clinical standard of Symon and Lavender, JOA Score for the spinal cord function, and the imaging standard for the spinal cord decompression the metaphase and prostecdtive efficacy of TARP operation was analyzed in 35 patients with intact clinical data at follow-up of 2-4 years （average 3 years）. Results The atlantoaxial dislocation of all the thirty-five patients in the group obtained completely or nearly anatomical reduction. No screw-loosening or atlantoaxial redislocation happened in 33 cases. According to the Symon clinical standard, 16 cases complete recovery, 7 mild type, 8 middle type, and 4 heavy type were found at the end of the follow-up compared to the preoperation 8 middle type, 15 heavy type, and 12 extremely heavy type. The clinical effective rate was 20%. The excellent rate was 80%. The postoperation improvement rate of spinal cord function was average 73.5%. The improvement rate of the decompression for the cervical cord was average 92.6%. The only complication was the screws loosening in two cases with senile osteoporosis. One ease underwent TARP overhauling operation and the other was performed posterior occipitocervical internal fixation. Both of them were cured eventually. No other complications such as infection and the injury of nervous system or blood vessel were found. Conclusion The TARP operation is a good choice for the patients with irreducible atlantoaxial dislocation and is very valuable for the clinical application.