【作者】 盛伟斌； 郭海龙； 买尔旦； 金格勒； 普拉提； 詹玉林；

【Author】 SHENG Weibin,GUO Hailong,PU Lati et al.Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinjiang Medical University,Xingjiang.830000, China.

【机构】 新疆医科大学第一附属医院脊柱外科；

【摘要】 目的:评价前路经口松解/减压联合后路固定融合治疗难复性寰枢椎脱位的安全性和有效性。方法:难复性寰枢椎脱位34例,男15例,女19例;年龄:6—69岁,平均38.9岁。其中先天性:29例,创伤性:2例,咽部炎症、NF和唐氏征各1例。均采用前路经口松解/减压联合后路固定融合术。术前、术后均行JOA评分。结果:均获随访6—96个月,平均20个月。气管切开麻醉23例,气管插管麻醉11例;枕颈固定14例,寰枢固定19例,C1—3固定1例。术前JOA评分平均7.8分,术后JOA评分平均13.5分。术后死亡3例,其中2例于2和6周发生感染,1例并发脱钉及椎动脉损伤,另1例合并脑脊液漏,1例发生呼吸衰竭。围手术期并发症包括感染3例,脑脊液漏2例,椎动脉损伤2例,腭裂1例,呼吸衰竭1例,骨折及脱钉2例。结论:对难复性寰枢椎脱位采用前路经口松解/减压联合后路固定融合是较为安全、有效的方法。该方法最大限度保留了结构,复位后减压满意,恢复了正常序列、疗效可靠。更多还原

【Abstract】 Objective To evaluate the safety and efficacy of treatment of irreducible atlantoaxial dislocation(IAAD) by transoral anterior release and posterior instrumentation. Methods Consecutive 34 patients with IAAD were treated by transoral anterior release and posterior instrumentation in our department from 1998 to 2007.There were 15 male and 19 female,mean age was 38.9 years.IAAD included congenital anomalies in 29 pa- tients,trauma in 2 patients,and inflammation、NF and Down syndrome in 1 case respectively. Preoperative imaging examination included anterioposterior、lateral、dynamic X-ray、MRI and CT reconstruction.IAAD was determined by skull traction and skull traction under general anesthesia before surgery.Neurological function was assessed by JOA scores before,after surgery,and at final follow-up.Results The average operation time was 280 mins,the average blood loss was 340ml.All patients were followed-up about 6-96 months,with an averaging 15 months.General anesthesia was performed by tracheostomy in 23 cases,tracheal intubation in 11 cases.19 cases underwent C1-2 instrumentation,craniovertebral in 14 cases,and C1-3 in 1 case.JOA scores increased from 7.8 to 13.5 after surgery,the ratio of recovery was 62%.3 cases died of infection,vertebral artery injury,and respiratory failure.Perioperative complications included infection in 3 cases,cerebrospinal fluid leakage in 2 cases,vertebral artery injury in 2 cases,cleft palate in 1 case,respiratory failure in 1 case,fracture with screw loosening in 2 cases.Conclusions Treatment of IAAD by anterior release and posterior instrumentation is a safe and effective method.Prevention of perioperative complications are important consideration for successful surgery.更多还原