本文選題：寰樞椎脫位 + 翻修手術　； 參考：《中國脊柱脊髓雜志》2017年03期

【摘要】：目的 :分析寰樞椎脫位手術后翻修的原因,探討其策略。方法 :回顧性分析15例寰樞椎脫位手術后翻修患者,男11例,女4例,翻修時年齡15~68歲(46.60±14.95歲);兩次手術相隔2~120個月(28.73±38.59個月)。根據影像資料及手術探查情況分析翻修原因。翻修手術中均行8~10kg顱骨牽引及后方松解;后方結構完整患者行后路固定,根據松解后復位情況決定是否選擇前路松解術;1例后路減壓患者行前路松解復位固定術。導航模板輔助置入寰樞椎螺釘;自體髂骨松質骨顆粒植骨。隨訪觀察寰樞椎復位、螺釘位置、植骨融合及手術療效。結果:翻修原因,減壓或復位不足10例,內固定失敗3例,植骨未融合3例(含植骨未融合致內固定失敗1例)。15例翻修手術中,14例為后路固定手術,1例為前路固定手術。通過術中顱骨牽引及充分松解,13例獲得解剖復位;2例因廣泛骨性融合,無法牽引復位,切除齒狀突后徹底減壓。導航模板輔助下共置入寰樞椎螺釘42枚,均一次性置入;置釘準確率97.6%。隨訪3~36個月(16.0±4.2個月),所有病例骨性融合,融合時間為3~6個月(3.7±0.5個月);末次隨訪JOA評分為13.8±3.1分(11~16分),較術前評分8.1±2.3分(6~11分)明顯提高,改善率為(64.0±21.2)%(45.4%~88.8%)。結論:寰樞椎脫位手術后翻修的原因為減壓或復位不足、內固定失敗以及植骨未融合。充分的術中松解、8~10kg的顱骨牽引、恰當的骨質切除減壓有利于翻修術中寰樞椎的復位,導航模板輔助有利于提高置釘準確性。
[Abstract]:Objective: to analyze the reasons for the refurbishment of atlantoaxial dislocation after surgery. Methods: a retrospective analysis of 15 cases of atlantoaxial dislocation after refurbishment, male 11, female 4, aged 15~68 years (46.60 + 14.95 years) and two months (28.73 + 38.59 months) during the refurbishment, and the analysis of the refurbishment according to the imaging data and surgical exploration. 8~10kg cranial traction and posterior loosening were performed during the refurbishment operation; the posterior structure intact patients were fixed after the posterior approach to decide whether to choose anterior release; 1 patients with posterior decompression were treated with anterior release and reduction and fixation. The navigation template assisted the atlantoaxial screw; autogenous iliac cancellous bone grafts. Atlantoaxial reduction, screw position, bone graft fusion and surgical effect. Results: repair causes, decompression or reduction of 10 cases, 3 cases of internal fixation failure, 3 cases of bone graft failure (including 1 cases of internal fixation failure due to bone graft failure), 14 cases for posterior fixation and 1 cases of anterior fixation, with cranial traction and adequate release during operation. 13 cases received anatomic reduction, 2 cases had no traction reduction and complete decompression after removal of odontoid process because of extensive bone fusion. A total of 42 atlantoaxial screws were inserted with the aid of navigation template. The accuracy rate of 97.6%. was followed up for 3~36 months (16 + 4.2 months), all cases of bone fusion, the time of fusion was 3~6 months (3.7 + 0.5 months); the last time was the last time. The follow-up JOA score was 13.8 + 3.1 (11~16), compared with the preoperative score of 8.1 + 2.3 (6~11), and the improvement rate was (64 + 21.2)% (45.4%~88.8%). Conclusion: the reasons for the refurbishment after atlantoaxial dislocation were decompression or reduction, internal fixation failure and unfusion of bone graft. Adequate intraoperative loosening, 8~10kg cranial traction, appropriate bone cutting. Besides decompression, it is beneficial to the reduction of atlantoaxial vertebrae during revision. Navigation template assistance is helpful to improve the accuracy of placement.
【作者單位】： 西安交通大學第二附屬醫(yī)院骨科;青島市市立醫(yī)院脊柱外科;
【基金】：國家自然科學基金資助項目(編號:81571209) 陜西省自然科學基金資助項目(編號:2016JM8054)
【分類號】：R687.3

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