陈旧性寰椎横韧带断裂的手术治疗

目的探讨陈旧性寰椎横韧带断裂的后路手术治疗。方法回顾性分析12例陈旧性寰椎横韧带断裂病例,患者病程为伤后3个月~2年,平均为12个月,患者均有程度不等的神经损伤表现。X线检查显示寰齿间距(ADI)为6~12mm。所有患者均接受Apofix固定并寰、枢椎融合术。本组患者术前均施行颅骨牵引,以获得寰枢关节复位或接近解剖复位。结果随访6个月~3年,所有患者术后均未出现寰、枢椎不稳定的表现。结论陈旧性寰椎横韧带断裂是导致寰、枢椎不稳定的重要原因之一。其诊断依赖于ADI测量及MRI检查。一旦诊断明确,后路寰枢椎融合术是一种有效的治疗方法。术前牵引复位是施行后路寰枢椎融合术的前提。

Surgical treatment for old disruption of transverse ligament of atlas

Objective To explore surgical treatment via posterior approach for old disruption of transverse ligament of atlas. MethodsTwelve cases with old disruption of transverse ligament of atlas were treated by posterior atlantoaxial arthrodesis with autologous bone graft and internal fixation with Apofix system. All the patients had neurological deficits in different degrees and were given skull traction for anatomic reduction of atlantoaxial joint before operation. Radiographic examinations demonstrated that the atlantodental interval (ADI) of the patients was from 6mm to 12mm. Results All the patients had improvement in neurological function after followed up for 6 months to 3 years postoperatively. There was no evidence of atlantoaxial instability in all cases after operation. Conclusion Old disruption of transverse ligament of atlas is an important cause to atlantoaxial instability. The diagnosis should depend on the measurement of ADI and examination of MRI. Posterior atlantoaxial arthrodesis is an effective way for the treatment of old disruption of transverse ligament of atlas once it has been diagnosed. Anatomic reduction of atlantoaxial joint by effective skull traction before operation is the precondition for a successful operation.