经前路和经后路手术治疗寰枢关节脱位

The anterior and posterior surgery for the treatment of atlantoaxial dislocation

目的比较经前路和经后路手术治疗寰枢关节脱位的疗效。方法回顾性分析显微外科手术治疗14例颅颈畸形合并寰枢关节脱位病人的临床资料,采取经口齿状突磨除术（前路手术组）6例,一次性后路减压复位螺钉-钛棒（板）系统内固定技术（后路手术组）8例,通过比较手术时间、JOA评分及神经电生理检测,评价经前路和经后路手术的临床疗效。结果手术时间：后路手术组（179.60±45.75）min,前路手术组（548.30±121.40）min,经后路手术时间明显减少（P〈0.05）。JOA术后评分：后路手术组（16.00±1.07）分,前路手术组（13.33±2.33）分,经后路JOA评分显著升高（P〈0.05）。手术出血量：后路手术组（153.80±72.30）ml,前路手术组（330.00±200.00）ml,两组差异无统计学意义（P〉0.05）。电生理检测结果：前路手术组术后波形完全恢复正常2例（50%）,后路手术组术后波形完全恢复正常5例（71.43%）,两组差异无统计学意义（P〉0.05）。随访6~48个月,平均25个月;影像学检查示枕颈区减压充分植骨区获得骨性融合。结论经后路治疗寰枢关节脱位较经前路更合理、可行。

Objective To compare the curative effect between the anterior and posterior surgery for the treatment of atlantoaxial dislocation.Methods Clinical data of 14 patients with atlantoaxial dislocation treated by microsurgery were analyzed retrospectively,including transoral odontoidectomy（anterior approach group） in 6 cases,and once posterior decompression reduction and internal fixation by screws-titanium rod（plate） fixation system（posterior approach group） in 8.The clinical efficacy of two surgical methods was evaluated based on the operative time,JOA scores and electrophysiological test.Results The operative time was 179.60 ± 45.75 min in posterior approach group and 548.30 ± 121.40 min in anterior approach group,the operative time of posterior approach significantly reduced（P0.05）.The postoperative JOA score was 16.00 ± 1.07 scores in posterior approach group and 13.33 ± 2.33 scores in anterior approach group,the JOA score of posterior approach significantly increased（P0.05）.The operative bleeding was 153.80 ± 72.30 ml in posterior approach group and 330.00 ± 200.00 ml in anterior approach group,and there was no significant difference between the two groups（P0.05）.The physiological test results： the waveform was completely normal in 2 cases（50%） in posterior approach group and in 5（71.43%） in anterior approach group postoperatively,and there was no significant difference between the two groups（P0.05）.The patients were followed up for mean period of 25 months,ranged from 6 to 48 months.Imaging examination revealed pillow neck area reduced pressure fully bone for osseous fusion area.Conclusions The surgery of posterior approach is more reasonable and feasible than anterior approach for the treatment of atlantoaxial dislocation.