单纯后路与前后联合入路手术治疗成年型齿突游离小骨并寰枢关节脱位

Posterior alone versus combined anterior and posterior approaches for treatment of os odontoideum and atlantoaxial dislocation in adults

[目的]探讨成年型齿突游离小骨继发寰枢关节脱位手术方式及其疗效。[方法]回顾性分析2010年9月~2014年9月收治的13例成年齿突游离小骨继发寰枢椎脱位患者,其中9例可复性脱位患者行单纯后路复位＋寰枢椎短节段固定融合术,4例难复性脱位者行前路经口咽减压联合后路寰枢椎融合术,随访术后临床表现及影像学改变。[结果]所有患者均获随访,随访时间1~5年,平均（2.5±1.1）年;术后影像学检查示患者均达到骨性融合,愈合时间3~9个月,平均（4.5±1.6）个月;无内固定松动、断裂等并发症,2例患者术后出现颈椎不适,但颈椎屈伸旋转功能无明显受限,对日常生活无明显影响。术后神经功能均得到明显改善,末次随访,JOA评分由术前平均（9.5±1.65）分提高到（14.2±1.6）分（P〈0.05）。[结论]后路短节段寰枢椎融合术是治疗成年型游离齿突伴寰枢关节脱位安全有效的治疗方法,可解除脊髓压迫,重建寰枢椎的稳定性,术后对枕颈部活动影响较小;难复性脱位患者,建议采用前路经口咽减压联合后路复位固定植骨融合术。

[ Objective ] To explore the surgical approaches and their efficacy for os odontoideum and atlantoaxial dislocation in adults. [ Method] A retrospective analysis was performed on 13 adult patients with oslodontoideum and atlantoaxial disloca- tion who were admitted to our hospital from September 2010 to September 2014. In those patients,9 patients with reducible at- lantoaxial dislocation were treated with posterior short -segment atlantoaxial fixation and fusion;4 patients with irreducible at- lantoaxial dislocation were treated with anterior transoral decompression and posterior athlntoaxial fusion. Clinical and radiologi- cal outcomes were regularly observed after surgery. [ Result] All the patients were followed up for 1 -5 years （mean,2.5 ~ 1.1 years）. Postoperative radiological results showed that all the patients had bony fusion ~in 3 - 9 months （ mean 4. 5 ~ 1.6 months）. There were no complications such as loosening or breakage of the internal devices. Two patients had cervical discomfort after surgery, however,without any substantial interference with cervical flexion and rotat{on or daily life. All patients had sub- stantial improvement in neurological function after surgery. At the final follow - up, the mean Japanese Orthopaedic Association score was significantly elevated compared with the preoperative one （ 14.2 ±1.6 vs 9.5 ±1.65 ,P 〈 0.05 ）. [ Conclusion] Posterior short - segment atlantoaxial fusion is a safe and effective approach for os odontoideum and atlantoaxial dislocation in a- dults,which can relieve spinal cord compression and reconstruct adantoaxial vertebral stability. For the patients with irreducible atlantoaxial dislocation, anterior transoral decompression combined with posterior atlantoaxial fixation and fusion is recommended.