难复性寰枢椎脱位的临床治疗观察

SURGICAL TREATMENT OF IRREDUCIBLE ATLANTOAXIAL DISLOCATION

目的探讨难复性寰枢椎脱位经颈前路松解、后路融合的临床疗效。方法2007年8月—2008年10月,我院对12例难复性寰枢椎脱位的病人进行外科手术治疗。所有病人术前常规行颅骨牵引,其中9例病人行经颈前路松解、后路寰枢椎融合术。3例病人行经颈前路松解、后路枕颈融合术。术后采用日本骨科学会(JOA)神经功能评分分析临床治疗效果。结果12例病人术后随访6～18个月,平均12个月。病人手术前后JOA评分比较差异有显著性(t=15.53,P<0.01)。寰枢椎及枕颈部植骨在半年左右均达骨性融合,未出现内固定物断裂、脱落。结论经颈前路松解、后路融合治疗难复性寰枢椎脱位均达到满意的临床效果,是一种合理可行的手术方法。

Objective To investigate the surgical efficacy through anterior loosening and posterior fusion for irreducible atlantoaxial dislocation （IAD）. Methods Twelve patients with IAL underwent surgery in our hospital from August 2007 to October 2008. All the patients received skull traction as routine before operation. Of whom, nine underwent anterior loosening and posterior atlantoaxial fusion, three anterior loosening and posterior occipital-cervical fusion. The postoperative assessment was conducted using the nerve function score of Japanese Orthopedic Association （JOA）. Results All the patients were followed up for mean （range） 12 （6--18） months. Differences between the preoperative and postoperative JOA scores were significant （t = 15.53, P〈0. 01）. Bony union of the graft bone was reached in about 6 months, with no broken or detachment of internal fixation material. Conclusion Trans-anterior approach for loosening or posterior for fusion in the treatment of irreducible atlantoaxial dislocation produces a satisfactory result, which is a reasonable and feasible tecnique.