寰枢关节脱位后路复位及螺钉-钛棒(板)内固定技术

Posterior restoration and screw-rod (plate) internal fixation technique for the treatment of irreducible atlantoaxial dislocation

目的探讨寰枢关节脱位后路复位及螺钉-钛棒(板)内固定技术的临床疗效。方法回顾性分析6例寰枢关节脱位病人的临床资料,其中先天性寰枢关节脱位5例,类风湿性关节炎所致1例;术前日本整形外科协会(JOA)评分平均(8.5±4.1)分。均行后路复位及螺钉-钛棒(板)内固定术,并根据术后JOA评分和影像学改善程度,评价手术疗效。结果术后影像学检查示:固定系统和寰枢关节复位良好5例,复位不良1例;骨性融合良好4例,欠佳2例。术后临床表现均不同程度好转,未出现严重并发症。随访1～14个月,平均2.4个月,JOA评分平均(11.8±3.5)分,与手术前比较,差异具有统计学意义(t=-5.976,P<0.01)。结论后路复位及螺钉-钛棒(板)内固定技术临床疗效良好,且减少病人的痛苦和费用,有广阔应用前景。

Objective To explore the clinical effect of posterior restoration and screw-rod （plate） internal fixation technique for the treatment of irreducible atlantoaxial dislocation.Methods Clinical data of 6 patients with irreducible atlantoaxial dislocation were analyzed retrospectively,including congenital irreducible atlantoaxial dislocation in 5 cases and 1 dislocation caused by rheumatoid arthritis.Japanese Orthopedic Association （JOA） score was used to evaluate the patient＇s condition,and the average score was 8.5 ± 4.1 preoperatively.Posterior restoration and screw-rod （plate） internal fixation technique were adopted in all the cases,and the surgical outcome was evaluatedaccording to JOA scores and imaging examination.Results Postoperative imaging examination showed that fixed systemandatlantoaxial restorationwere performedwell in5 cases andbadly in1.The bony fusionwas performedwell in4 cases andbadly in 2.Clinical symptoms were improved to different extents postoperatively,and no severe complications occurred.All the patients were followed up for median period of 2.4 months,ranged from 1 to 14 months.The average JOA score was 11.8 ± 3.5.Compared with preoperation,the postoperative JOA scores was significantly improved （t =-5.976,P 0.01）.Conclusions Posterior restoration and screw-rod（plate） internal fixationtechnique will be usedwidely inthe future due to the goodclinical results,low costandminimal pain.