【摘要】：[目的]探討采用改良Harms釘棒技術(shù)治療寰椎枕骨化的寰樞椎脫位患者的可行性和價(jià)值。[方法]2012年1月~2014年1月,采用改良Harms釘棒技術(shù)治療寰椎枕骨化的寰樞椎脫位患者11例,男7例,女4例;年齡14~60歲,平均為33.4歲。11例患者均存在不同程度的慢性進(jìn)展性四肢無力和感覺異常。術(shù)前均行X線片、CT及MRI檢查,術(shù)前JOA評分11~14分,平均13.3分。記錄手術(shù)時(shí)間、手術(shù)失血量、術(shù)中及術(shù)后并發(fā)癥。術(shù)后常規(guī)行X線片、CT檢查以評估復(fù)位情況及內(nèi)固定位置。出院后常規(guī)門診隨訪。[結(jié)果]11例均成功進(jìn)行了對枕骨化的寰椎及樞椎的釘棒固定融合術(shù)。手術(shù)時(shí)間90~160 min,平均119 min,術(shù)中出血量150~300 ml,平均245 ml。術(shù)中無椎動脈、靜脈叢、神經(jīng)根、脊髓及硬膜損傷。術(shù)后無感染、C2神經(jīng)功能障礙及枕部皮膚壓瘡。全部患者均獲得隨訪,隨訪時(shí)間9~28個(gè)月,平均19個(gè)月�；颊呔@得骨性融合,無內(nèi)固定松動、移位及斷裂。11例癥狀均獲得不同程度緩解,末次隨訪JOA評分14~17分,平均15.8分。[結(jié)論]應(yīng)用改良Harms釘棒技術(shù)對寰椎枕骨化的寰樞椎脫位患者行寰樞椎釘棒復(fù)位、固定及融合是治療該類患者的一種簡單、有效的方法,避免了使用枕頸內(nèi)固定器械所帶來的并發(fā)癥;與Goel技術(shù)相比,操作更簡便,并且能夠避免術(shù)后C2神經(jīng)功能障礙。
[Abstract]:Objective] to evaluate the feasibility and value of modified Harms technique in the treatment of atlantoaxial dislocation. [methods] from January 2012 to January 2014, 11 patients (7 males and 4 females) with atlantoaxial dislocation were treated with modified Harms screw technique. The average age was 33.4 years old (140-60 years). All the 11 patients had chronic progressive limb weakness and abnormal sensation. X-ray, CT and MRI were performed before operation. The preoperative JOA score was 11 ~ 14 (mean 13.3). The operative time, blood loss, intraoperative and postoperative complications were recorded. X-ray films and CT were performed to evaluate the reduction and the position of internal fixation. Routine outpatient follow-up after discharge. [results] 11 cases of occipital atlas and axis were treated successfully. Operative time: 90 min, 160 min, mean intraoperative blood loss, 150 ml, 300 ml, average 245 ml. No vertebral artery, venous plexus, nerve root, spinal cord or dural injury were found during the operation. There was no infection, C 2 nerve dysfunction and occipital skin pressure sore. All patients were followed up for 9 ~ 28 months (mean 19 months). Bone fusion was achieved without internal fixation loosening displacement and rupture. The symptoms of 11 patients were relieved to varying degrees. The JOA score of the last follow-up was 14 ~ 17 with an average of 15. 8. [conclusion] modified Harms screw rod technique is a simple and effective method for the treatment of atlantoaxial dislocation. The complications caused by the use of occipitocervical internal fixation instruments are avoided. Compared with Goel technique, it is easier to operate and can avoid C 2 neurological dysfunction after operation.
【作者單位】： 西安交通大學(xué)醫(yī)學(xué)部附屬紅會醫(yī)院脊柱外科;
【分類號】：R687.3

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