寰枢椎脱位翻修手术原因及策略研究进展

Research progress of causes and strategies in revision surgery for atlantoaxial dislocation

寰枢椎脱位(atlantoaxial dislocation,AAD)是一种由多学科常见病导致的可危及生命的寰枢椎结构不稳定和一系列神经功能障碍,由于毗邻延髓,位置深在,手术风险极高。随着上颈椎区域手术数量增加,术后内固定失败、植骨未融合、预后不良等并发症逐渐增多,初次手术不彻底、植骨未融合、感染、先天性畸形均是潜在病因,且考虑到移植物、瘢痕、解剖标志的变化等客观因素,翻修手术难度进一步增加。然而目前缺乏标准或单一有效的翻修手术方法:单纯前路手术是理论上的理想选择,但存在较高风险,且对术者经验性要求较高;单纯后路手术存在复位减压不充分等缺陷;前路减压联合后路固定融合是较合理术式,然而需考虑后方结构完整性和多节段融合等多方面问题。本文对AAD的翻修手术原因及策略作一综述。

Atlantoaxial dislocation(AAD)is a kind of life-threatening atlantoaxial structural instability and a series of neurological dysfunction caused by common multidisciplinary diseases.The operation risk is extremely high because it is adjacent to the medulla oblongata and the location is deep.With the increase of the number of operations in the upper cervical region,postoperative complications such as failure of internal fixation,non fusion of bone graft and poor prognosis gradually increase.Incomplete primary operation,non fusion of bone graft,infection and congenital malformation are the potential causes.In addition,considering the objective factors such as previous graft,scar formation and anatomical marks changes,revision surgery is further difficult.However,there is currently no standard or single effective revision surgery method.Simple anterior surgery is an ideal choice in theory,but it has high risk and high empirical requirements for the operator;simple posterior surgery has some defects,such as insufficient reduction and decompression;anterior decompression combined with posterior fixation fusion is a more reasonable surgical procedure,but many problems such as posterior structural integrity and multilevel fusion need to be considered.This article reviews the causes and strategies of AAD revision surgery.