齿状突游离所致寰枢椎脱位的外科治疗

The surgical treatment of atlantoaxial subluxation derived from Os odontoiddeum

目的总结齿状突游离小骨导致寰枢椎脱位患者的临床治疗经验。方法回顾分析2004年10月至2010年3月宣武医院神经外科治疗的10例齿状突游离小骨所致寰枢椎脱位患者的临床经验。采用颈后路寰枢椎椎弓根螺钉或枕颈螺钉内固定植骨融合术进行治疗，术前、术后采用JOA评分评价手术疗效。结果手术平均时间3h，未发生与手术相关并发症，术后8例患者症状改善，2例患者症状无明显变化，术前与术后3个月JOA评分差异有统计学意义。术后3个月复查寰枢椎均达到复位和骨性融合。结论采用寰枢椎椎弓根螺钉或枕颈螺钉内固定技术治疗齿状突小骨可以有效地进行寰枢椎之间的融合，改善齿状突小骨导致的神经功能症状。

Objective To summarize the clinical characteristic and the results of surgical treatment of atlantoaxial subluxation patients derived from Os odontoiddeum. Method The clinical materials of 10 cases with Os odontoidum were reviewed and analyzed. Posterior approach atlas and axis pedicle screws or occipital screws and axis pedicle screws were applied to internal fix and fuse the atlas and axis. Before and post operation JOA scores were compared to evaluated the effects of the surgical treatment. Results Average operation time is about 3 hours, no operation related complications happened. The symptoms approved in 8 cases, and kept invariant in 2 cases. Post operation JOA scores were improved significantly. Reduction and bony fusion between atlas and axis were found in all cases 3 months post operation. Conclusions Internal fixation with pedieal screws between atlas and axis is safe and effective method to treat Os odontoidum, and approve the symptoms of the patients.