前路松解与后路钉棒置入融合治疗难复性寰枢关节脱位:1年随访

Ventral release and posterior screw/rod implant fusion for irreducible atlantoaxial dislocation: one-year follow-up

背景:经口前路松解后路融合内固定已成为治疗难复性寰枢关节脱位的主流治疗方法,但目前还缺乏长期疗效观察。目的:观察经口前路松解后路融合及钉棒置入内固定治疗难复性寰枢关节脱位的临床疗效。方法:经口前路松解后路融合内固定治疗难复性寰枢关节脱位患者32例,治疗后行颈椎正侧位数字化DR及颈椎MRI影像学检查了解神经压迫解除情况和骨性融合情况;治疗前、治疗后6个月及末次随访时采用JOA评分评定患者神经功能恢复情况。结果与结论:治疗后29例获得随访,平均随访12个月。①所有患者均获得良好的寰枢关节复位和骨性融合,实现了复位与重建脊柱稳定性的双重目的。②所有患者治疗后脊髓受压明显减轻,神经功能均获得不同程度改善,治疗后6个月及末次随访JOA评分与治疗前比较,差异均有显著性意义(P<0.05)。③所有患者治疗过程中均无脊髓、椎动脉损伤等严重并发症发生,治疗后无感染、破溃等并发症发生。④影像学检查显示,经口前路松解后路融合内固定是治疗难复性寰枢关节脱位的一种安全有效的方法。

BACKGROUND：Transoral ventral release and posterior fusion have predominated in the treatment of irreducible atlantoaxial dislocation, but there is no consistent conclusion on the clinical efficacy. OBJECTIVE：To explore the clinical outcomes of transoral ventral release and posterior fusion and screw/rod implantation in the treatment of irreducible atlantoaxial dislocation. METHODS：A total of 32 patients with irreducible atlantoaxial dislocation undergoing thetransoral ventral release and posterior fusion were selected. After treatment, they received cervical anteroposterior and lateral digital DR and cervical MRI examinations to understand the conditions of nerve compression and bone fusion. The recovery of nerve function was evaluated using Japanese Orthopaedic Association before treatment, 6 months after treatment and during final fol ow-up. RESULTS AND CONCLUSION：Post-treatment, 29 patients were fol owed-up for an average period of 12 months. （1） Al the patients obtained perfect atlantoaxial joint reduction and bone fusion. This achieved reduction and reconstruction of spinal column stability. （2） Spinal compression was obviously lessened after treatment in al patients, and nerve functions were improved to different degrees. Significant differences in Japanese Orthopaedic Association score were detected between 6 months post-treatment, final fol ow-up and pre-treatment （P〈0.05）. （3） There were no serious intraoperative complications such as spinal cord or vertebral artery injuries. Postoperative complications such as infection or burst were also not found. （4） Imaging evaluation revealed that transoral ventral release and posterior fusion is safe and effective for treatment of irreducible atlantoaxial dislocation.