椎弓根钉棒系统及综合复位技术治疗青少年齿状突游离小骨伴寰枢椎脱位的研究

Atlantoaxial Pedicle Screw-rod System and Compound Reduction Technique for Adolescent with Os Odontoideum Associated Atlantoaxial Dislocation

目的评估后路寰枢椎椎弓根螺钉内固定系统在治疗青少年游离齿状突小骨伴寰枢椎脱位患者中的长期临床效果,并介绍一种针对难复性寰枢椎脱位的综合复位技术。方法回顾性研究2014年1月~2016年9月期间在笔者医院手术治疗的21例游离齿状突小骨伴寰枢椎脱位的12~18岁青少年患者,所有患者均采用后路寰枢椎椎弓根螺钉复位固定系统治疗,对于5例术前通过颅骨牵引不能达到满意寰枢椎复位的患者应用了综合提拉复位的手术技术。通过术前术后颈椎过伸过屈位的影像学资料,测量以下指标:寰椎椎管内径(inner diameter of the atlantal ring,D atl)、椎管最小径(minimum diameter of the spinal canal,D min)、椎管最大径(maximum distance of the spinal canal,D max)、寰齿前间距(atlantodens interval,ADI)、延髓脊髓角(cervico-medullary angle,CMA)、C2~C7 Cobb角、并随访术前术后JOA和NDI评分。采用独立样本t检验比较患者术前术后各项指标。结果所有患者术后均获得满意的寰枢椎复位及神经症状改善,术中未发生神经损伤、椎动脉损伤等并发症,所有患者随访24~48个月,颈椎功能障碍指数(NDI)从17.4±6.7分改善为10.1±3.6分,JOA评分从11.2±1.9分提高到14.4±1.9分。术后随访影像学数据表明,C2~C7 Cobb角由术前25.4°±10.5°变为17.2°±6.4°。寰椎椎管内径从术前16.6±2.1mm变为16.7±2.4mm,椎管最小直径从9.1±2.4mm明显改善为15.3±1.9mm,寰齿前间距(ADI)由术前1.5±0.7mm变为术后1.5±0.6mm。延髓脊髓角(CMA)由术前135.2°±7.6°明显改善为152.0°±6.1°。结论后路寰枢椎椎弓根螺钉固定系统在治疗青少年游离齿状突畸形伴寰枢椎脱位中能够获得较满意的长期临床疗效。同时采用的综合提拉复位方法在难复性寰枢椎脱位的治疗中初步得到满意复位效果。

Objective To assess the clinical outcome of the posterior C1-C2 pedicle screws fixation for the adolescent patients with os odontoideum(OO)associated atlantoaxial dislocation(AAD)and we introduce a compound reduction technique for the reduction of atlantoaxial dislocation(IrAAD).Methods Twenty one adolescent patients(12-18 years old)diagnosed as OO associated AAD and treated in our department between January 2014 and September 2016 were retrospectively reviewed.All the patients were treated by C1-C2 pedicle screw fixation.For 5 patients showed irreducibility of C1-C2 dislocation after traction,posterior compound reduction technique was performed.Radiographic parameters were measured through the radiological data of the upper cervical spine with the neck in a neutral position,flexion or extension:inner diameter of the atlantal ring(D atl),minimum diameter of the spinal canal(D min),maximum distance of the spinal canal(D max),atlantodens interval(ADI),cervico-medullary angle(CMA),C2-C7 Cobb.Preoperative and postoperative clinical signs and symptoms were measured by NDI and JOA scores.The data were compared using the paired t test.Results All patients got satisfactory realignment and improvement of neurological symptoms after surgery.No neurological injuries,vertebral artery injuries or any other complications were identified during or after operations.the follow-up.All patients were followed up for 24-48 months.The mean NDI scores changed from 17.4±6.7 to 10.1±3.6,and JOA scores improved from 11.2±1.9 to 14.4±1.9.Radiological data showed that C2-C7 Cobb angle changed from 25.4±10.5 degrees to 17.2±6.4 degrees.The inner diameter of the atlantal ring changed from preoperative 16.6±2.1mm to 16.7±2.4mm.The atlantodens interval(ADI)changed from 1.5±0.7mm to postoperatively 1.5±0.6mm.The smallest diameter of the spinal canal changed from 9.1±2.4mm to 15.3±1.9mm.Cervico-medullary angle recovered from 135.2±7.6 degrees to 152.0±6.1 degrees.Conclusion C1-C2 pedicle screw fixation could achieve satisfactory outcomes for the adolescent patients with OO associated AAD.Direct posterior compound reduction technique could achieve satisfactory realignment for the patients with IrAAD.