经颈前路松解后路融合一期手术治疗难复性寰枢椎半脱位

目的 探讨经颈前路松解后路融合一期手术治疗难复性寰枢椎脱位的方法及其可行件.方法 男10例,女6例;平均年龄36岁.陈旧性外伤性13例,类风湿性2例,先大性齿突游离l例.颈前路松解取仰卧位,头颈稍过伸并偏向左侧约30°.取下颌角下方2 cm与下颌水平平行至胸锁乳突肌内侧缘,并沿胸锁乳头肌内侧缘延长到C4水平一斜形切u.分离显露至寰椎前弓至颈3椎体.切除双侧寰枢关节的关节囊、齿突与寰椎或枢椎的纤维瘢痕组织,切断翼状韧带和齿突尖韧带,在"C"型臂X线机监视下牵引复位,牵引重量2 kg,颈部过伸位,如果不能复位,则以0.5 kg逐渐增加重量,时间间隔为10min,以便观察电牛理的变化.复位寰枢椎,待复位满意后颈围保护下翻身,再次在"C"型臂X线机下监视,调整头架,观察寰枢椎位置满意后,用lkg重量颅骨牵引,维持头颈的稳定性.一期后路行寰枢椎固定融合.术后1年内每3个月米院复查,1年后每6个月米院复查.结果 所有患者获得15～40个月随访.全部病例均获得骨性融合.16例复位满意.12例术前有脊髓症状者JOA评分术前平均8_3分,术后6个月甲均13.9分,平均改善87.5％.结论 经颈前路松解后路融合一期手术治疗难复性寰枢椎半脱位效果满意.

One stage anterior solution with posterior fusion for difficult reduce atlantoaxial subluxation

Objective To analyze the feasibility of one stage anterior solution with posterior fusion for difficult reduce atlantoaxial subluxation.nethods There were 10 males and 6 females.with the mean age of 36 years,including 13 cases suffered old trauma,2 cases for rheumatoid,1 case for congenital dens free.Anterior solution was performed On supine position.hyperextension and tum left about 30°.Incision beloW angle of the iaw about 2 em and parallel the medial hordcr of sternomastoid muscle and extend to fourth eervical vertebrae.Reveal the arch of anterior atlas to third cervical vertebrae and cut the articular capsule of articulatio atlantoepistrophicas and sear tissue.Then cut off the alar ligaments and odontoid ligament and traction reduction on the monitoring of C-arm machine.Traction reduction on hyperextension wan done with the weight of 2 kg.If reduction was not succeeded,the weight should be added 0.5 kg by degrce on 1 0 minutes interval.Reduction the atlas and vertebra dentate and turn the body over on protect of neck collar.Adjust the headframe on the monitoring of C-arm machine.Skull traction should be done to keep stability with1 kg weight.Atlas and vertebra dentate was fixed and fused by one stage.All patients maw the doctors every 3 months in the first year.and ten every 6 months.They should visit every 3 months on the first year after surgery and 6 months on the second year.Results A11 patients were followed up from 1 5 Lo 40 months.and got bone fusion.1 6 patients were reduced to anatomy position.1 2 patients with cord symptom JOA improw;from 8.3 to 13.9.6 months postoperatively.and the mean improving rate was 87.5%.Conclusion The mcthod of one stage anterior solution with posterior fusion for djfficult reduce atlantoaxial subluxation iS satisfied.