中国修复重建外科杂志

中国修复重建外科杂志

经颈前咽后入路前路松解二期后路复位融合内固定术治疗难复性寰枢关节脱位

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目的 探讨经颈前咽后入路前路松解二期后路复位融合内固定术治疗难复性寰枢关节脱位的疗效。 方法 2012 年 2 月—2016 年 8 月,收治 15 例难复性寰枢关节脱位患者。男 9 例,女 6 例;年龄 14~53 岁,平均 31.4 岁。病程 3 个月~17 年,平均 5.7 年。其中因外伤后继发寰枢关节脱位 13 例,先天性齿状突不连继发寰枢关节脱位 2 例。术前影像学检查均提示寰枢关节脱位,在功能位上无法自行复位。疼痛视觉模拟评分(VAS)为 3~7 分,平均 4.1 分;日本骨科协会(JOA)评分为 10~17 分,平均 13.8 分。采用一期经颈前咽后入路前路松解后,继续颅骨牵引,二期经后路复位植骨融合内固定术治疗。 结果 所有患者均达解剖复位,恢复寰枢关节正常序列,术后颈痛及神经症状均部分改善甚至完全恢复,均未出现脊髓损伤加重。 1 例一期术后出现咽部不适、饮水呛咳,4 例术后有不同程度的咽部不适、异物感,2 例于颅骨牵引过程中出现钉道口红肿,均行对症处理后治愈。治疗过程中未出现肺部感染、压疮、下肢静脉血栓形成、切口感染等。15 例患者均获随访,随访时间 24~36 个月,平均 28.6 个月。植骨均获骨性融合,融合时间 3~5 个月,平均 3.6 个月。末次随访时 VAS 评分为 0~2 分,平均 0.5 分;JOA 评分为 13~17 分,平均 15.9 分。末次随访时复查颈椎 X 线片及三维 CT 均未见脱位复发及其他异常征象。 结论 采用一期经颈前咽后入路前方松解、二期经后路植骨融合内固定术治疗难复性寰枢关节脱位可达到解剖复位,是一种可供选择的术式。

Objective To discuss the effectiveness of atlantoaxial joint release through anterior retrophayngeal approach and staged posterior reduction fixation and fusion for irreducible atlantoaxial dislocation (IAAD). Methods Fifteen patients with IAAD (9 males, 6 females), aged 14-53 years (mean, 31.4 years) were included in the study. The disease duration was 3 months to 17 years (mean, 5.7 years). IAAD was attributed to trauma in 13 cases, and 2 cases were caused by congenital odontoid disconnection. Preoperative imaging examination showed atlantoaxial dislocation and could not be reset automatically in functional position. The preoperative visual analogue scale (VAS) score was 3-7 (mean, 4.1), and the preoperative Japanese Orthopaedic Association (JOA) score was 10-17 (mean, 13.8). All patients received atlantoaxial joint release through anterior retrophayngeal approach and staged posterior fixation and fusion. Results Anatomical reduction was achieved in all 15 patients, and the alignment of atlantoaxial joints was restored. After operation, the neck pain and neurological symptom were partially or fully improved in all patients, without deterioration of neurological function. One patient developed pharyngeal discomfort and cough after one-stage operation, 4 patients developed pharyngeal discomfort and foreign body sensation after operation, and 2 patients developed pin-path lipstick swelling during skull traction. All patients were cured by symptomatic treatment. No pulmonary infection, pressure ulcers, venous thrombosis, and incision infection was found during the treatment. All 15 patients were followed up 24-36 months, with an average of 28.6 months. Bony fusion was achieved in all patients, and the fusion time was 3-5 months, with an average of 3.6 months. At last follow-up, the VAS score was 0-2 (mean, 0.5) and the JOA score was 13-17 (mean, 15.9). There was no dislocation, recurrence, or other abnormal sign in the cervical X-ray films and three-dimensional CT. Conclusion Anatomical reduction can be achieved by atlantoaxial joint release through anterior retrophayngeal approach and staged posterior fixation and fusion for treating IAAD. It is an optional procedure for IAAD.

关键词: 寰枢关节脱位; 颈前咽后入路; 前路松解; 后路融合术

Key words: Atlantoaxial dislocation; anterior retrophayngeal approach; anterior release; posterior fusion

引用本文: 袁杨, 雷飞, 周春光, 刘立岷, 宋跃明. 经颈前咽后入路前路松解二期后路复位融合内固定术治疗难复性寰枢关节脱位. 中国修复重建外科杂志, 2018, 32(11): 1377-1381. doi: 10.7507/1002-1892.201712121 复制

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