齿状突游离小骨合并寰枢椎脱位的外科治疗临床经验

目的总结齿状突游离小骨合并寰枢椎脱位患者外科治疗的经验。方法回顾性分析唐都医院神经外科2010年8月~2015年12月治疗的9例齿状突游离小骨合并寰枢椎脱位患者的临床资料。所有患者均采用颈后路寰枢椎椎弓根螺钉或者枕颈螺钉内固定植骨融合术进行治疗,统计并比较术前术后影像学测量指标(改良寰齿前间距MADI,脊髓可用间隙SAC)及JOA评分评价手术疗效。结果 9例患者均成功实施手术,无手术相关并发症发生;术后患者的症状均明显改善,MADI明显缩小,SAC明显增加,颈髓角135°;手术前和手术后3个月时的JOA评分比较,差异有统计学意义(P0.05);术后3个月时复查寰枢椎均达到复位和骨性融合。结论对齿状突游离小骨合并寰枢椎脱位患者,采用术中寰枢椎复位,寰枢椎椎弓根螺钉或枕颈螺钉内固定术可以有效进行寰枢椎的融合,固定效果良好,缓解脊髓受压,改善了齿状突游离小骨及寰枢椎脱位导致的神经功能症状。

Clinical experience in surgical treatment of Os odontoideum combined with reducible atlantoaxial dislocation

Objective To summarize the experience of surgical treatment for Os odontoideum combined with reducible atlantoaxial dislocation .Methods The clinical data of 9 patients with Os odontoideum combined with reducible atlantoaxial dislocation , who admitted in our hospital from August 2010 to December 2015 were analyzed retrospectively . All patients were treated with atlantoaxial pedicle screw or occipital cervical screw internal fixation with bone graft treatment . MADI, SAC and JOA score were counted and compared in pre-operation and post-operation. Results All cases were successfully performed and no one case have occurred complications . Symptoms improved significantly , MADI was significantly reduced , SAC increased significantly and Cervico-medullary angle >135 degrees in 9 patients after operation .JOA score had statistical significance ( P<0 .05 ) compared with before and after operation , atlantoaxial reached reduction and bony fusion after three months . Conclusions The mechanism of OS odontoideum with atlantoaxial dislocation is complex , using the method of atlantoaxial reduction combining atlantoaxial pedicle screw fixation or occipitocervical screw internal fixation is effective , it will has satisfied atlantoaxial fusion , stable fixation and good spinal cord decompression , it will improve the neurological recorvery caused by Os odontoideum combine with atlantoaxial dislocation .