【摘要】：目的:評(píng)估雙側(cè)經(jīng)寰樞關(guān)節(jié)螺釘寰椎椎板鉤固定植骨融合治療可復(fù)性寰樞椎脫位的中長(zhǎng)期療效。方法:回顧性分析85例在我院接受雙側(cè)經(jīng)寰樞關(guān)節(jié)螺釘寰椎椎板鉤固定植骨融合術(shù)的可復(fù)性寰樞椎脫位患者的臨床資料,其中男21例,女64例;年齡25~65歲(44±9.4歲)。寰椎爆裂性骨折19例,C1、2旋轉(zhuǎn)脫位畸形16例,齒狀突骨折26例,齒狀突游離15例,寰椎類(lèi)風(fēng)濕性關(guān)節(jié)炎致寰樞椎脫位9例。通過(guò)Ranawat分級(jí)、頸椎功能障礙指數(shù)(NDI)以及頸部/枕骨下疼痛視覺(jué)模擬量表(visual analogue scale,VAS)評(píng)分評(píng)估患者的臨床療效;在術(shù)前和末次隨訪時(shí)的頸椎正側(cè)位X線片、MRI、CT三維重建等資料中,提取以下影像學(xué)數(shù)據(jù):寰齒前間距(atlanto-dental interval,ADI)、有效椎管容積(space available for cord,SAC)、C1-2角、C2-7角,并觀察植骨融合情況及頸椎穩(wěn)定性。結(jié)果:所有患者均完成5年以上的隨訪。末次隨訪時(shí)24例術(shù)前存在脊髓壓迫癥狀患者的Ranawat分級(jí)有所改善;95%的患者頸部疼痛得到緩解,VAS評(píng)分由術(shù)前7.56±1.03分下降至2.53±0.53分(P0.05);NDI由術(shù)前34.76±5.45分降至13.13±1.21分(P0.05)。ADI由術(shù)前6.5±1.0mm降至2.4±0.9mm(P0.05);SAC由術(shù)前13.37±2.11mm增大至19.93±2.20mm(P0.05)。手術(shù)前C1-2角為21.9°±1.2°,末次隨訪時(shí)為26.6°±6.9°;手術(shù)前C2-7角為19.8°±9.2°,末次隨訪時(shí)為15.5°±5.9°。術(shù)后6個(gè)月,81例(95.3%)患者獲得良好的植骨融合,4例患者出現(xiàn)植骨延遲愈合。結(jié)論:雙側(cè)經(jīng)寰樞關(guān)節(jié)螺釘寰椎椎板鉤固定植骨融合治療可復(fù)性寰樞椎脫位的長(zhǎng)期療效優(yōu)良,是一種安全、可靠的后路寰樞椎固定融合技術(shù)。
[Abstract]:Objective: to evaluate the long-term treatment of atlantoaxial dislocation with bilateral transatlantoaxial screw fixation. Methods: the clinical data of 85 patients with atlantoaxial dislocation underwent bilateral transatlantoaxial screw fixation with laminar hook fixation were retrospectively analyzed, including 21 males and 64 females, aged 2565 years (44 鹵9.4 years). There were 19 cases of burst fracture of atlas, 16 cases of C1M 2 rotation dislocation, 26 cases of odontoid fracture, 15 cases of free odontoid process, 9 cases of atlantoaxial dislocation caused by atlantoid rheumatoid arthritis. The clinical efficacy was evaluated by Ranawat grade, cervical spine dysfunction index (NDI) and cervical / occipital pain visual analogue scale (visual analogue scale,VAS). The following imaging data were extracted from the X-ray films of anterior and lateral cervical vertebrae before operation and at the last follow-up, MRI,CT 3D reconstruction and so on: anterior atlantodentate spacing (atlanto-dental interval,ADI), effective spinal canal volume (space available for cord,SAC), C1-2 angle, and so on. C 2-7 angle, bone graft fusion and cervical stability were observed. Results: all patients were followed up for more than 5 years. At the last follow-up, the Ranawat grade of 24 patients with spinal cord compression symptoms was improved, 95% of the patients were relieved of neck pain, the VAS score decreased from 7.56 鹵1.03 to 2.53 鹵0.53 (P0.05). NDI decreased from 34.76 鹵5.45 to 13.13 鹵1.21 (P0.05). ADI from 6.5 鹵1.0mm to 2.4 鹵0.9mm) (P0.05); SAC increased from 13.37 鹵2.11mm to 19.93 鹵2.20mm (P0.05). The angle of C1-2 was 21.9 擄鹵1.2 擄before operation, 26.6 擄鹵6.9 擄at last follow-up, 19.8 擄鹵9.2 擄before operation and 15.5 擄鹵5.9 擄at last follow-up. After 6 months, 81 patients (95.3%) had good bone graft fusion and 4 patients had delayed union. Conclusion: bilateral transatlantoaxial screw fixation and bone grafting for atlantoaxial dislocation is a safe and reliable posterior approach for the treatment of atlantoaxial dislocation.
【作者單位】： 第二軍醫(yī)大學(xué)附屬長(zhǎng)征醫(yī)院脊柱四科;
【分類(lèi)號(hào)】：R687.3

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