经口咽前路寰枢椎复位钢板系统的设计及其即时复位作用(附5例临床报告)

Treatment of irreducible atlantoaxial dislocation by transoropharyngeal atlantoaxial reduction plate system:a report of 5 cases

目的 研制经口咽前路寰枢椎复位钢板系统 (TARP) ,并评价其术中即时复位作用。方法 设计一种新型的经口咽前路寰枢椎复位钢板系统 ,应用于临床治疗 5例难复型寰枢椎脱位患者 ,经口咽前路松解减压 ,联合应用寰枢椎复位器和钢板完成寰枢椎脱位的复位和固定过程 ,寰枢外侧关节间植骨。结果 TARP系统具有即时复位机制 ,5例患者在术中均能达到良好的即时复位。术后随访平均 9.5个月 ,伤口愈合良好 ,无感染 ,四肢麻痹消失 ,肌力恢复 ,病理反射消失 ,钢板螺钉未松动。结论 临床应用表明 ,TARP设计新颖独到 ,手术操作简便合理 ,能即时复位 ,固定效果好 。

Objective To evaluate transoropharyngeal atlantoaxial reduction plate system (TARP) and its preliminary clinical effect. Methods The TARP system was designed to consist of a butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other surgical instruments. The system was applied clinically to five irreducible atlantoaxial dislocations as a result of injury or congenital disorders. During the operation, the reduction was achieved through the combination of the plate and the atlantoaxial reductor after the transoropharyngeal brisement and decompression. Bone graft was implanted between the lateral atlantoaxial joints. Results The reduction mechanism of the TARP system was well designed. Its clinical application to five cases of irreducible atlantoaxial dislocation proved that TARP had the function of instant reduction and that the operation was feasible and had laudable effect. Conclusion TARP design is a novel strategy. Its operative procedure is simple and feasible. Both the instant reduction and stable fixation can be obtained during the operation. TARP is creative and has excellent prospect.