齿状突疾患合并寰枢椎脱位的手术治疗

Surgical Treatment of Odontoid Disorders Associated with Atlantoaxial Dislocation

目的 :评价各种类型手术治疗齿状突疾患并寰枢椎脱位的临床应用效果。方法 :回顾性分析 1995年 6月～ 2 0 0 0年 4月间收治的 32例齿状突疾患合并寰枢椎脱位的病例 ,其中齿状突骨折 2 0例 ,齿状突畸形 10例 ,齿状突骨巨细胞瘤 2例。后路C1～ 2 钢丝固定 5例 ,Apofix椎板夹 5例 ,寰枢椎侧块螺钉 6例 ,不能复位者行枕颈融合术 8例 ,前路齿状突螺钉固定 6例 ,前后路联合手术 (前路肿瘤切除 ,后路寰枢椎融合 ) 2例 ,所有术式均行自体或异体骨植骨融合术。结果 :术后随访 14个月～ 5年 ,平均 2年 6个月 ,30例获得坚强骨愈合 ,2例不愈合。无术中、后并发症 ,亦无内固定松动、脱出 ,断裂 ,及肿瘤复发转移。结论 :运用多种术式治疗齿状突疾患合并寰枢椎脱位 ,只要适应证选择恰当 ,其结果是令人满意的 ,其中对能复位的寰枢椎脱位以前路或后路螺钉固定与植骨融合术最为简单、安全、有效 ,值得推广应用。

Objective: To evaluate the clinical outcomes in the treatment of odontoid diseases associated with atlantoaxial dislocation by all kinds of operations. Methods: Retrospective analysis thirty-two cases of odontoid diseases associated with atlantoaxial dislocation were encountered from June 1995 to April 2000. Odontoid fracture 20,odontoid deformity 10, odontoid tumor 2. Posterior fixation with wiring 5, Apofix 5, C 1,2 lateral mass screw fixation 6, occipitocervical fusion were performed after not reduction 8, anterior odontoid screw 6, anterior combined with posterior operation (anterior, tumor excision, posterior fixation and fusion)2,all types of operations performed by auto or allograft. Results: The patients were followed up for an average of two years and six months(range 14 months～5 years),solid fusion were seen in thirty patients and nonunion in two cases. There were no other complications and hardware failure. Conclusion: If selected the accurate operative methods, it could get satisfactory clinical outcomes in the surgical treatment of odontoid diseases associated with atlantoaxial dislocation. Anterior and posterior screw fixation after reduction trans odontoid or C 1,2 lateral mass and bone graft is a more effective, simple operative method.