后路关节松解撬拨复位治疗寰枢椎脱位

Clinical study of posterior joint release and lever reduction for atlantoaxial dislocation

目的探讨后路内镜辅助下360°松解撬拨复位治疗寰枢椎脱位(atlantoaxial dislocation,AAD)的安全性和有效性。方法回顾性分析31例采用后路手术的AAD病例资料。术中内镜辅助下360°松解寰枢关节囊,撬拨器松解关节、复位固定。测量手术前后的寰齿前间隙(atlantodental interval,ADI)、斜坡-椎管角(clivus-canal angle,CCA)、齿状突(odontoid process)顶点高出Chamberlain线的高度(O-CL),使用改良日本骨科协会评分(m JOA)评价神经功能恢复情况。结果术后1周内ADI由术前(5.00±2.87) mm,减小至(1.35±1.40) mm,CAA由术前(126.40±13.58)°,增大到(138.60±10.15)°,O-CL由术前(9.69±5.06) mm,减少至(3.00±2.62) mm。术后6个月随访25例,m JOA评分由术前(10.32±3.77),提高至(12.88±3.73)。上述数据手术前后比较,差异均有统计学意义(P <0.01)。结论后路内镜辅助寰枢关节松解撬拨复位治疗AAD安全、有效,为手术治疗AAD提供了一种方法选择。

Objective To investigate the efficacy and safety of 360° atlantoaxial joint release and levering for reduction of atlantoaxial dislocation(AAD). Methods Clinical data of 31 patients with AAD who underwent posterior approach surgery were analyzed retrospectively. Atlantoaxial joint capsule was released through 360° under the assistance of endoscope and the joint was released,reduced and fixed by a levering device. The atlantodental interval(ADI), the clivus-canal angle(CCA), and the height of the odontoid process above the Chamberlain line(O-CL) were measured before and after operation. The effect of nerve function recovery was evaluated by modified Japanese Orthopaedic Association score(mJOA). Results One week after the operation, ADI decreased from preoperative 5.00 ± 2.87 mm to postoperative 1.35 ± 1.40 mm, CAA increased from(126.40 ± 13.58)° to(138.60 ± 10.15)° and O-CL decreased from 9.69 ± 5.06 mm, to 3.00 ± 2.62 mm. The m JOA score of 25 cases was followed up for 6 months after the operation, and increased from(10.32 ± 3.77) to(12.88 ± 3.73) before operation. There were statistically significant differences in the above data(P <0.01). Conclusions Posterior endoscope-assisted atlantoaxial joint lease and lever reduction techniques are safe and effective in the treatment of AAD, thus providing a method for surgical treatment of AAD.