寰枢关节360°松解在经口寰枢椎复位钢板内固定术治疗僵硬难复性寰枢椎脱位中的应用

目的探讨在经口寰枢椎复位钢板(TARP)内固定术中采用寰枢关节360°松解技术治疗僵硬难复性寰枢椎脱位的临床疗效。方法 2005年1月—2014年12月,对23例常规方法不能彻底松解的僵硬难复性寰枢椎脱位患者采用寰枢关节360°松解TARP内固定术治疗。通过术前、术后影像学检查(X线、CT三维重建和MRI)判断寰枢椎复位、内固定器位置及脊髓受压改善情况。采用日本骨科学会(JOA)评分评估患者临床症状改善情况。结果所有患者手术均顺利完成,术后颈椎局部症状和肢体麻木无力均不同程度改善,术后影像学资料显示内固定位置满意,脊髓压迫均彻底解除。所有患者术后随访6~12个月(平均9.3个月),末次随访时JOA评分由术前(8.5±3.2)分提高至(13.2±2.1)分;所有患者均获骨性融合。除1例患者因术中硬膜破裂,二期拆除TARP改为后路枕颈固定,其他患者未发生感染、神经血管损伤、钉板松脱等并发症。结论按常规方法不能完成充分松解的由陈旧性骨痂和瘢痕等因素造成的僵硬难复性寰枢椎脱位,采用寰枢关节360°松解技术可以获得彻底松解,再行TARP内固定术即可完成寰枢关节的完全复位,彻底解除脊髓压迫。

Application of 360° atlantoaxial release in transoral atlantoaxial reduction plate internal fxation for stiff irreducible atlantoaxial dislocation

Objective To investigate the clinical efficacy of transoral atlantoaxial reduction plate(TARP) internal fixation with 360° atlantoaxial release for the treatment of stiff irreducible atlantoaxial dislocation. Methods From January 2005 to December 2014, 23 patients with stiff irreducible atlantoaxial dislocation which can not be completely loosened by conventional methods were treated with 360° atlantoaxial release and TARP fixation. The reduction of the atlantoaxial joint, the position of the internal fixator and the improvement of the spinal cord compression were judged by preoperative and postoperative imaging examination (roentgenograph CT 3D-reconstruction and MRI). The clinical symptom improvement of the patients was assessed by the Japanese Orthopaedic Association(JOA) score. Results All surgeries were performed successfully. After operation, the local symptoms of cervical vertebra and numbness of limbs were improved to varying degrees. The postoperative imaging data showed that the position of internal fixation was satisfactory and the compression of spinal cord was completely relieved. All patients were followed up for 6-12 months, mean 9.3 months. JOA score improved from preoperative 8.5±3.2 to 13.2±2.1 at the final follow-up. All patients received bone fusion, and no postoperative complications occurred except 1 case requiring second-stage posterior occipitocervical fixation for intraoperative dura tear. Conclusion For the patients with stiff irreducible atlantoaxial dislocation, routine release technique can not achieve complete release. However, 360° atlantoaxial release could release the stiff atlantoaxial joints owing to old bone callus and scar tissue so as to receive ideal atlantoaxial reduction, and complete spinal cord decompression could be completed with the help of the following TARP operation.