寰枢椎脱位的诊断与治疗

Diagnosis and treatment of atlantoaxial dislocation

寰枢椎脱位是寰枢椎间的稳定性丧失导致寰枢关节对应关系发生错位的一种病理解剖状态,是脊柱外科严重的致残性疾病,甚至可能危及患者生命。寰枢椎脱位的病因包括创伤性、先天性、炎症性、退变性与肿瘤等因素,临床上由于症状和体征不具有特异性,因此影像学检查尤为重要。寰枢椎脱位主要根据病因学、寰枢椎相对位置关系、复位难易程度进行分类,准确的分类对治疗方案的选择有重要意义。寰枢椎脱位的手术指征尚未形成普及度较高的指南或共识,患者表现相关症状或脊髓神经功能损害是临床上公认度较高的手术指征。手术方式仍以后路术式为主,随着寰枢椎置钉、复位及融合技术的不断改进和优化,以及脊柱外科新兴设备的辅助,手术相关风险及并发症发生率大幅降低,寰枢椎脱位的手术治疗可获得良好的复位和融合效果。因此对寰枢椎脱位的病因、诊断、分类、治疗、并发症和预后进行归纳,以期为寰枢椎脱位的临床诊治提供参考意见。

Atlantoaxial dislocation is a pathological anatomical condition caused by the loss of stability between the atlantoaxial joints,which is a serious disabling disease in spine surgery,and may even endanger the patient's life.The causes of atlantoaxial dislocation include traumatic,congenital,inflammatory,degenerative,tumor,and other factors.Since the symptoms and signs are not specific in clinic,imaging examination is particularly important.Atlantoaxial dislocation is mainly classified according to the etiology,the relative position of atlas and axis,and the difficulty of reduction.Accurate classification is of great significance for the selection of treatment options.There is no popular guideline for surgical indications of atlantoaxial dislocation.Patients presenting with related symptoms or spinal cord dysfunction are generally recognized surgical indications in clinical practice.With the continuous improvement and optimization of atlantoaxial screw placement,reduction and fusion technology,supplemented by new equipment in spine surgery,the surgery-related risks and complications have been greatly reduced,and the surgical treatment of atlantoaxial dislocation can obtain good reduction and fusion results.This tutorial summariz the etiology,diagnosis,classification,treatment,complications,and prognosis of atlantoaxial dislocation,in order to provide a more complete and refined reference for clinical diagnosis and treatment.