寰枢椎脱位与不稳定388例住院病例分析

Clinical analysis of 388 cases of atlanto-axial instability

目的分析不同原因引起的寰枢椎脱位与不稳定的特点，为诊断、治疗的改进提供参考。方法对 1975年 1月～ 2000年 4月收治的寰枢椎脱位或不稳定患者 388例作回顾性分析。结果寰枢椎发育异常引起的寰枢椎脱位 262例，创伤性寰枢椎脱位 71例，其他原因 55例。发育异常中骨性畸形 238例，包括枢椎齿突发育异常、寰椎枕化、颅底凹陷等，以单纯枢椎齿突畸形最为多见，但出现脊髓损害的比例没有显著性差异。随着病史的延长出现脊髓损害的可能性增加，出现重症脊髓损害的可能性也明显增加。陈旧性骨折比新鲜骨折复位更困难。陈旧性骨折 (35例 )中有 19例伤后脊髓损害加重。伤后超过 1年的陈旧性骨折患者，症状加重的发生率明显高于病史不足 1年者。结论畸形等发育性异常导致寰枢椎脱位与不稳定比创伤性原因更常见，一旦出现临床症状应积极治疗。创伤性寰枢椎脱位患者应早期积极治疗，避免晚期脊髓损害加重。

Objective To study the clinical characteristics of atlanto-axial dislocation and instability caused by different reasons. Methods 388 cases of atlanto-axial dislocation and instability admitted between Jan 1975 and Apr 2000 were reviewed retrospectively. Results 262 cases were caused by anomaly, 71 by trauma and 55 by other reasons. 238/262 had bony deformity, including anomaly of odontoid process, atlanto-occipital assimilation, skull basilar invagination and some others. Simple anomaly of odontoid was the most commonly seen etiology. Myelopathy occurred at similar morbidity among each kind of patients. But patients who presented symptoms for longer time were more likely to have myelopathy. It is difficult to reduce chronic fractures of the odontoid process compared with the fresh fractures. 19 cases with chronic fracture suffered from severe myelopathy. Patients with chronic atlanto-axial fracture over 1 year were more likely to have secondary damage of spinal cord than those within 1 year. Conclusion Atlanto-axial dislocation and instability is more commonly caused by anomaly than trauma. Once the patients with atlanto-axial anomaly present clinical signs, they should be treated as soon as possible. Traumatic atlanto-axial instability should be treated at the early stage to avoid myelopathy.