一期前方咽后入路松解后路融合治疗难复性寰枢椎脱位

One stage solution and posterior fusion surgery through the high anterior cervical retropharyngeal approach for irreducible atlantoaxial dislocation

目的探讨一期颈椎前方高位咽后入路松解后路寰枢椎融合治疗难复性寰枢椎脱位的可行性及效果。方法本组共收治难复性寰枢椎脱位患者12例。入院后患者均常规行颅骨牵引术,常规行颈椎X线、MRI和CT三维重建检查评估寰枢椎脱位情况。所有患者采用前方高位咽后入路显露寰枢椎关节囊,去除寰枢椎之间的瘢痕、骨赘进行松解,一期在持续颅骨牵引下行后路寰枢椎椎弓根螺钉提拉复位、固定,并取髂骨植骨融合。采用日本骨科协会(JOA)评分评估术前和术后1年的神经功能。结果所有病例术后随访12～28个月,平均18个月。1例患者术后出现舌下神经麻痹,术后2个月恢复。无脑脊液漏及食道、神经和椎动脉损伤。JOA术前为(9.3±1.1)分,术后1年(15.6±1.2)分,两者相差显著(P<0.05)。所有患者均植骨融合、内固定位置良好。结论一期颈椎前方高位咽后入路松解后路寰枢椎融合是治疗难复性寰枢椎脱位的有效方法。

Objective To explore the feasibility of one stage solution and posterior fusion surgery through the high anteriorc ervical retropharyngeal approach for irreducible atlantoaxial dislocation and its curative effect.Method The solution and posteriorf usion surgery was performed in 12 patients（age range,26～58 years;mean age,46 years） with irreducible atlantoaxial dislocation,ofw hom,8 were males and 4 females.All the patients received skull traction and the translocation and rotation of the atlas were assessedb y X-ray,MRI and CT three-dimensional reconstruction before the surgery in all the patients.The articular capsules of articulatioa tlantoepistrophicas were exposed and the scar tissue and steophyma were resected by the surgery.With continuous skull traction,thea tlas was reduced and fixed with pedicle screws and the atlantoaxial fusion was performed by iliac bone graft during one stage surgery.J apanese orthopaedic Association（JOA） score system was used to evaluate the clinical outcomes before the surgery and 12 months aftert he surgery.Results All the patients were followed up from 12 to 28 months（mean,18 months） .Hypoglossal palsy occurred in onep atient,who recovered from hypoglosed palsy 2 months after the surgery.The nerves,vertebral arteries and esophagus injuries,andl eakage of cerebrospinal fluid were not observed in all the patients.JOA score[（15.6±1.1） points]was significantly higher 12 months aftert he surgery than that[（9.3±1.1） points]before the surgery（P0.05） .The grafted bones was well fused into the receptor bones and therew as good internal fixation in all the patients.Conclusion The one stage solution and posterior fusion surgery through the high anteriorc ervical retropharyngeal approach is an effective method to treat the irreducible atlantoaxial dislocation.