后路寰枢椎融合术在青少年寰枢椎旋转脱位患者中的疗效分析

Posterior atlantoaxial fusion in the treatment of adolescent atlantoaxial rotatory dislocation

目的评价后路寰枢椎融合术治疗青少年寰枢椎旋转脱位的临床疗效。方法回顾性分析2019年10月至2021年5月于华中科技大学同济医学院附属同济医院行后路寰枢椎融合术治疗的5例青少年寰枢椎旋转脱位患者的完整临床资料,记录手术时间、术中出血量、并发症,并比较患者术前与术后1周寰齿前间距(ADI)、寰齿侧间隙差值(VBLADI)、延髓脊髓角(CMA)、脊髓储备空间(SAC)、疼痛评分量表(VAS)、日本骨科学会(JOA)颈椎评分等指标。结果5例患者均获得随访,随访时间为6~19个月,平均12个月。术后1周ADI、VAS低于术前,CMA、SAC高于术前,差异有统计学意义(P<0.05);术后1周VBLADI低于术前,JOA评分高于术前,差异无统计学意义(P>0.05)。5例患者均未发生椎动脉损伤、脊髓神经损伤、内固定失败等严重并发症。结论应用后路寰枢椎融合术治疗青少年寰枢椎旋转脱位,能安全、有效地恢复上颈椎的解剖关系,显著缓解颈痛,改善神经症状和矫正斜颈畸形。

Objective To evaluate the clinical effect of posterior atlantoaxial fusion in the treatment of adolescent atlantoaxial rotatory dislocation(AARD).Methods The clinical data of 5 adolescents with AARD who underwent posterior atlantoaxial fusion in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from October 2019 to May 2021 were retrospectively analyzed.The operation time,intraoperative blood loss and complications were recorded,and the atlantodental interval(ADI),variance of bilateral lateral atlantodental interval(VBLADI),cervicomedullary angle(CMA),space available for the cord(SAC),visual analogue score(VAS),Japanese Orthopaedic Association(JOA)scores were compared before and after operation.Results The patients were followed up for an average of 12 months(6-19 months).The ADI and VAS were lower than that before operation,SAC and CMA were significantly improved compared with preoperative(P<0.05 for all).The VBLADI was lower than that before operation and the JOA score was higher than that before operation,however,the differences were not statistically significant(P>0.05 for both).No serious complications such as vertebral artery injury,spinal cord injury,and implant failure occurred in 5 patients during and after operation.Conclusion Posterior atlantoaxial fusion in the treatment of adolescent atlantoaxial rotatory dislocation can safely and effectively restore the anatomical relationship of the upper cervical spine,relieve neck pain significantly,improve neurological symptoms and correct torticollis.