一期前路松解后路固定治疗难复性寰枢椎脱位

Single-stage anterior atlantoaxial release and sequential posterior instrumented fusion for irreducible atlantoaxial dislocation

[目的]介绍一期颈前咽后入路松解后路复位固定融合治疗难复性寰枢椎脱位的手术技术与初步疗效。[方法] 2016年3月~2019年1月应用颈前咽后入路寰枢松解后路复位固定融合治疗难复性寰枢椎脱位患者38例。患者首先取仰卧位,经Smith-Robinson入路显露寰枢关节腹侧结构,去除寰枢关节周围瘢痕韧带等实现寰枢松解;然后,在石膏床保护下改为俯卧位,行寰枢椎后路钉棒复位固定及植骨融合。[结果]本组患者均顺利完成手术,所有患者均获得满意复位,无神经、血管损伤等严重并发症。平均随访(32.54±7.63)个月,所有病例均实现骨性融合,无内固定失效及再脱位。末次随访时JOA评分、寰齿前间距和延髓脊髓角均较术前显著改善(P<0.05)。[结论]颈前咽后入路松解联合后路钉棒复位固定融合是治疗难复性寰枢椎脱位的可靠手术方法。

[Objective] To introduce surgical technique and clinical outcomes of single-stage anterior atlantoaxial release and sequential posterior instrumented fusion for irreducible atlantoaxial dislocation. [Methods] From March 2016 to January 2019, a total of 38 patients underwent single-stage operations, including atlantoaxial release through anterior cervical retropharyngeal approach and sequential posterior instrumented fusion, for irreducible atlantoaxial dislocation. As patient was placed in supine, ventral structures of the atlantoaxial articulation were exposed through Smith-Robinson approach, the scar and ligament around the atlantoaxial articulation were resected to achieve atlantoaxial release. After that, the patients were placed in prone position with temporal fixation of plaster cast bed to finish posterior atlantoaxial reduction, pedicle screw fixation and bone grafting. [Results] All patients had the surgeries performed successfully to achieve satisfactory atlantoaxial reduction without serious complication, such as injury to blood vessels and nerves. The patients were followed up for an average of(32.54±7.63) months, and all of them got bony fusion to the latest follow up, no implants failure and atlantoaxial re-dislocation were identified during the follow-up in anyone of them. The JOA score, ADI and CMA improved significantly at the latest follow up compared with those before operation(P<0.05). [Conclusion] The single-stage anterior atlantoaxial release and sequential posterior instrumented fusion is a reliable technique for irreducible atlantoaxial dislocation.