摘要
目的通过临床病例分析探讨不稳定性齿突游离小骨的临床特点及后路融合手术的治疗效果。方法回顾性分析2005年5月-2012年5月本院采用手术治疗有临床症状的不稳定性齿突游离小骨患者26例。分析总结病史特点、临床表现、影像学表现及手术治疗效果。结果 26例患者中男16例,女10例。年龄36-66岁,平均43.3岁。15例既往有明确外伤史,21例患者有颈部症状,所有患者均有不同程度的神经损伤症状,术前神经功能日本骨科学会(Japanese Orthopaedic Association,JOA)评分8-15分,平均10.1分。所有患者影像学均有寰枢椎脱位表现,其中22例为可复性,有2例伴有上颈椎其他畸形。24例行后路寰枢椎融合术,2例行枕颈融合术,术中无椎动脉、脊髓损伤发生,术后平均随访26个月(12-36个月),26例患者均达到骨性融合,无内固定松动、断裂等并发症。术后12个月,颈部症状及神经功能明显改善,JOA评分为12-17分,平均15.1分(P〈0.05)。结论不稳定性齿突游离小骨容易损伤脊髓,应尽早手术重建其稳定性,经后路融合手术安全有效。
Objective To analyze the clinical characteristics of unstable os odontoideum and determine the efficiency of the treatment by retrospective study. Methods From May 2005 to May 2012,26 patients with unstable os odontoideum were treated by posterior fusion. The clinical characteristics,clinical feature,imaging manifestations and therapeutic effect of operation were analyzed. Results Among 26 patients,16 patients were males and 10 females,the mean age was 43. 3 years( range 36-66 years). There was a history of significant,previous trauma in15 patients. And21 patients presented neck pain.Neurological signs and symptoms of myelopathy were present in all patients and the mean Japanese Orthopaedic Association( JOA) score was 10.1( 8-15). Atlantoaxial dislocation were found in all patients. Posterior atlantoaxial fusion was performed in 24 patients and occipitocervical fusion in 2 patients. All patients were followed up for 12 to 36 months( average,26months). All patients gained solid bony fusion. No vertebral artery or spinal cord injuries caused by operative procedure occurred. There was no fixator failure during the follow-up period. One year later,All patients had a relief of local symptoms and neurological symptoms,the mean JOA score was 15. 1( 12-17). Conclusion Patients with unstable os odontoideum are at risk of spinal cord injury. Posterior fusion allows restoration of the spinal stability and can get effective results and less complications.
出处
《脊柱外科杂志》
2014年第3期152-155,共4页
Journal of Spinal Surgery
关键词
齿突尖
寰枢关节
关节不稳定性
脊柱融合术
Odontoid process
Atlanto-axial joint
Joint instability
Spinal fusion