经口咽前路松解复位后路椎弓根螺钉内固定治疗难复性寰枢椎脱位

Transoral release and posterior reduction by pedicle screw instrumentation for the treatment of irreducible atlantoaxial dislocation

目的:探讨经口咽前路松解后路寰枢椎椎弓根螺钉复位内固定治疗难复性寰枢椎脱位的临床疗效。方法:2004年3月～2006年7月共收治11例难复性寰枢椎脱位患者,临床症状均有四肢麻木并进行性加重。术前神经功能JOA评分6～12分,平均8.5分,均施行经口咽前路寰枢椎松解,一期后路寰枢椎椎弓根螺钉系统进一步提拉复位、内固定、植骨融合术,随访观察临床疗效并进行X线、CT、MRI等影像学检查,观察复位、内固定及植骨融合情况。结果:平均手术时间4.3h,平均出血量630ml,术中出现硬膜破裂1例,椎弓根钉切割1例,未出现椎动脉损伤和脊髓损伤加重患者。随访12～24个月,平均16个月,术后1年时神经功能JOA评分10～17分,平均13.5分,平均改善率58.8%。手术后颈椎旋转功能均有不同程度的丢失,旋转范围为80°～120°,平均100°。所有患者均获得解剖复位、植骨融合,无内固定失败者。结论:经口咽前路寰枢椎松解复位后路椎弓根螺钉提拉复位、内固定、植骨融合术,对难复性寰枢椎脱位有较好的临床疗效。

Objective：To investigate the clinical efficacy of transoral release and posterior reduction by pediele screw instrumentation for the treatment of irreducible atlantoaxial dislocation.Method：From March 2004 to June 2006,a total of 11 patients with progressive paralysis at extremties due to irreducible atlantoaxial dislocation underwent one-stage transoral release and posterior reduction and fusion by pedicle screw instrumentation.The clinical outcome was reviewed by JOA score system and the radiological results were assesed by X- ray,CT scan and three-dimensional reconstruction and MRI.Result：The mean preoperative JOA scores were 8.5 （range,6 to 12）.The average operative time was 4.3h,with the average blood loss of 630ml.Intraoperative cerebral-spinal fluid leakage occurred in 1 case ,and pedicle screw perforation in 1 case.There were no severe complications such as injury to vertebral artery and spinal eord.ll cases were followed up for an average of 16 months（range, 12 to 24 months）.The postoperative JOA scores at one year were 10 to 17,with an average of 13.5,with the average improve rate of 58.8%.Some degree of axial rotation loss was evidenced with the mean ROM of 100°（range,80° to 120°）.All patients finally achieved anatomic reduction and bony fusion with no instrument failure.Conclusion：Transoral release and posterior reduction by pedicle screw instrumentation for the treatment of irreducible atlantoaxial dislocation is reliable and effective.