引用本文:郑佳状1,蒋电明2,张亨闰1,张 智1,蔡奇霖1,汪凡栋1,陈 宇1,邓 文1.一期前后路手术治疗难复性寰枢关节脱位17例[J].重庆医科大学学报,2013,(11):1281~1285
一期前后路手术治疗难复性寰枢关节脱位17例
Surgical treatment of irreducible atlantoaxial dislocation with single-stage anterior and posterior approach in 17 cases
DOI:
中文关键词:  寰枢关节脱位  椎弓根螺钉  经口咽入路
英文关键词:atlantoaxial dislocation  pedicle screw  transoral approach
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作者单位
郑佳状1,蒋电明2,张亨闰1,张 智1,蔡奇霖1,汪凡栋1,陈 宇1,邓 文1 1. 四川省遂宁市中心医院脊柱外科遂宁 6290002. 重庆医科大学附属第一医院骨科重庆 400016 
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中文摘要:
      目的:总结一期前路经口咽松解复位后路固定融合治疗难复性寰枢关节脱位的临床疗效。方法:2006年11月-2011年8月,共收治难复性寰枢关节脱位17例,男10例,女7例,年龄31~68岁,平均46.5岁,其中陈旧性齿状突骨折9例,先天性游离齿状突3例,先天性寰椎枕骨融合畸形3例,类风湿性关节炎2例。日本骨科协会(Japanese Orthopaedic Association,JOA)评分为4~11分,平均(7.47±2.15)分。所有患者在麻醉状态下颅骨牵引均不能复位。采用前路经口咽寰枢关节松解复位,同期行后路固定融合,其中经寰枢椎椎弓根固定融合13例,经枢椎椎弓根枕颈固定融合4例。结果:所有患者平稳渡过围手术期,无椎动脉脊髓损伤、切口感染等并发症,并获得9~56个月随访,平均32.6个月。所有患者均获得解剖复位和植骨融合,末次随访时JOA评分11~17分,平均(14.70±2.22)分。结论:前路松解复位后路固定融合治疗难复性寰枢关节脱位具有复位充分、减压彻底、稳定性重建好等优点。
英文摘要:
      Objective:To summarize the therapeutic effect of single-stage anterior release and reduction through oral pharynx and pos-terior fixation and fusion for irreducible atlantoaxial dislocation. Methods:Seventeen cases of irreducible atlantoaxial dislocation were treated in our hospital from November 2006 to August 2011 including 10 males and 7 females aged from 31 years to 68 years(aver-aged 46.5 years). The 17 patients included 9 patients with obsolete odontoid process fracture,2 with inborn dissociation odontoid pro-cess,4 with atlan-occipital fusion deformation,2 with rheumatoid disease. Japanese Orthopaedic Association(JOA) scores ranged from 4 to 11 with an average of 7.47±2.15. All dislocation could not be reduced through skull traction under anesthesia. Anterior release and reduction through oral pharynx was performed and posterior fixation and fusion was performed by one stage. Among posterior fix-ation and fusion,13 were performed through atlantoaxial pedicle,4 were performed through dentata pedicle and occipital. Results:All patients pulled through perioperative period securely. Complication including arteria vertebralis injury,spinal cord injury and incision infection were not occurred. All patients were followed up for 9 to 56 months,with an average of 32.6 months. All patients gained anatomic reduction and bone fusion. At latest time follow up,JOA scores ranged from 11 to 17 with an average of 14.70±2.22. Conclusions:With the merits of sufficient reduction,thorough decompression and good spinal column stability reconstruction,single-stage anterior release and reduction through oral pharynx and posterior fixation and fusion is effective in the treatment of irreducible atlantoaxial dislocation.
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