前路松解复位后路融合治疗游离齿突继发环枢椎脱位

目的: 探讨经高位咽后入路前路松解、后路融合治疗游离齿突继发的难复性环枢椎脱位。方法: 本组 3例, 均为男性, 年龄 17~36岁, 无明显创伤史, 颅骨牵引 2~3周, 采用高位咽后入路显露C1~3, 行环枢前方松解复位, Ⅰ期后路环枢融合, Brooks法钛缆内固定。结果: 3例游离齿突继发的难复性环枢椎脱位, 术前颅骨牵引不能复位, 经前路手术松解达到良好复位, 后路环枢融合良好, 内固定无松脱, 无伤口感染。3例患者神经症状均明显改善。结论: 经高位咽后入路行前方松解, 能够复位游离齿突继发的难复性环枢椎脱位, Ⅰ期后路环枢融合可获良好的植骨融合。     

一期前路松解后路固定治疗难复性寰枢椎脱位

[目的]介绍一期颈前咽后入路松解后路复位固定融合治疗难复性寰枢椎脱位的手术技术与初步疗效。[方法] 2016年3月～2019年1月应用颈前咽后入路寰枢松解后路复位固定融合治疗难复性寰枢椎脱位患者38例。患者首先取仰卧位,经Smith-Robinson入路显露寰枢关节腹侧结构,去除寰枢关节周围瘢痕韧带等实现寰枢松解;然后,在石膏床保护下改为俯卧位,行寰枢椎后路钉棒复位固定及植骨融合。[结果]本组患者均顺利完成手术,所有患者均获得满意复位,无神经、血管损伤等严重并发症。平均随访(32.54±7.63)个月,所有病例均实现骨性融合,无内固定失效及再脱位。末次随访时JOA评分、寰齿前间距和延髓脊髓角均较术前显著改善(P0.05)。[结论]颈前咽后入路松解联合后路钉棒复位固定融合是治疗难复性寰枢椎脱位的可靠手术方法。     

一期前路松解后路椎弓根钉固定融合治疗难复性寰枢椎脱位

目的 探讨经口咽入路前路松解一期后路寰枢椎椎弓根钉内固定植骨融合治疗难复性寰枢椎前脱位的临床疗效,方法 2005年1月～2010年2月,采用经口咽入路前路松解,一期后路寰枢椎椎弓根钉内固定植骨融合治疗难复性寰枢椎脱位合并高位颈脊髓压迫共21例.男15例,女6例;年龄26～70岁,平均51岁;病程6～30年.陈旧性齿状突...     

儿童齿状突游离小骨继发寰枢关节脱位的术式选择及疗效观察

目的 :探讨儿童齿状突游离小骨继发寰枢关节脱位的手术方式,并观察其临床疗效。方法 :2009年1月~2014年1月收治12例儿童齿状突游离小骨继发寰枢椎脱位患者,其中7例可复性脱位患者行后路寰枢椎融合术,4例难复性脱位或复位后脊髓前方存在压迫的患者行前路经口咽减压联合后路寰枢椎融合术,1例难复性脱位患者行前路经口咽减压联合后路枕颈融合术,术后1、3、6、12个月及末次随访时评估患者临床表现及影像学改变。结果:所有患者均获得随访,随访时间28±15个月(12~60个月);术后患者临床症状均得到明显改善,11例短节段融合固定患者颈部屈伸活动功能良好,轴向旋转稍受限;1例患者术后8个月出现内固定断裂及寰枢椎脱位,行后路翻修手术后6个月植骨融合,其余患者均在术后6.0±2.5个月(3~12个月)植骨融合。末次随访时,患者JOA评分由术前的9.6±1.4分提高到16.2±0.7分。结论:后路植骨融合内固定术是治疗儿童齿状突游离小骨继发寰枢关节脱位安全有效的方法,对于难复性脱位患者或复位后存在软组织对脊髓构成持久压迫的患者需联合前路经口咽减压。     

经口咽齿突切除结合H—V环复位治疗重度陈旧性寰枢椎脱位

目的：探讨经口咽齿突切除结合H－V环复位治疗重度陈旧性寰枢椎脱位的方法及重度寰枢椎脱位的病理机制。方法：对2例重度陈旧性寰枢椎脱位患者采用经口咽齿突切除前方松解、减压,结合H－V环缓慢复位,二期行后路减压枕颈融合方法治疗。结果：1例术前Frankel C级恢复至正常,1例术前Frankel C级恢复至D级。结论：重度陈旧性寰枢椎脱位,在寰椎前弓与枢椎体间形成纤维组织增生,这种纤维连接使寰枢椎相对趋向稳定是障碍复位的主要因素。结合H－V环缓慢牵引,复位制动,经口咽入路行齿突切除前方松解减压,二期行后路减压枕颈融合,确能从前后方解除致压因素,结合H－V环制动、复位能够保障复位和手术过程中头颈部的运动在H－V环控制下,对手术和复位提供了极大的安全保证。     

经口咽入路松解Ⅱ期后路器械融合治疗寰枢椎脱位

目的：评价经口咽入路松解、Ⅱ期后路器械融合治疗陈旧性寰枢椎脱位。方法：经口咽入路寰枢椎前方松解颅骨牵引复位、Ⅱ期后路寰枢椎融合内固定治疗6例陈旧性寰枢椎脱位患者,术后对脊髓功能和颈椎影像学进行评定。结果：术后2年脊髓功能改善2级3例,改善1级2例,无变化1例。术后X线显示寰枢椎复位理想和后方融合满意,MRI显示脊髓压迫解除。结论：经口咽入路行寰枢椎前方松解后颅骨牵引复位、Ⅱ期后路器械融合术治疗陈旧性寰枢椎脱位,临床和影像学评估满意。     

前路松解复位后路内固定治疗难复性寰枢关节脱位

目的：探讨难复性寰枢关节脱位的手术治疗方法。方法：对3例难复性寰椎前脱位的病例经口咽入路切断颈长肌、头长肌、前纵韧带和寰枢侧块关节囊，施行松解复位术，同期行后方固定植骨融合术。后方固定方法包括：经寰枢侧块关节螺钉固定、寰枢侧块钉板固定和借助于枢椎椎弓根螺钉的枕颈固定。结果：3例均获得了解剖复位和植骨融合。结论：经口咽入路的寰枢关节松解复位术可使难复性脱位的寰枢关节获得充分复位，松解复位术是一种安全、有效的治疗方法。     

两种不同手术方式治疗难复性寰枢椎脱位并颅底凹陷效果对比研究

目的 评价经颈前咽前路松解结合枕颈融合内固定术与单纯后路枕颈融合内固定术治疗难复性寰枢椎脱位并颅底凹陷的临床效果.方法 回顾性分析2015-01—2019-06郑州大学第一附属医院收治的32例难复性寰枢椎脱位并颅底凹陷患者的临床资料,按手术方式分为经颈前咽前路松解结合枕颈融合内固定术组(前后路联合组)和单纯后路枕颈融合...     

内镜辅助下经高位颈前咽后入路治疗寰枢椎脱位的手术配合

目的探讨内镜辅助下经高位颈前咽后入路治疗寰枢椎脱位的围手术期护理。方法对19例寰枢椎脱位患者采用内镜辅助下经高位颈前咽后入路完成前路松解复位手术,同时Ⅰ期行后路固定植骨融合术。结果19例患者均获得解剖复位,随访6～24个月,均获得骨性融合,术中出现硬脊膜破裂1例,经硬脑膜补片修补及生物蛋白凝胶封堵,术后腰椎蛛网膜下腔置管引流1周后治愈,末次随访时,无一例患者发生感染及内固定松动。结论内镜辅助经高位颈前咽后入路是治疗寰枢椎脱位的安全、有效、微创的方法,充分的术前准备,严密的术中配合,精心的术后护理,可以缩短手术时间,提高手术成功率。     

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.     

高位颈椎的前路手术治疗

目的观察高位颈椎前路手术的临床效果,方法本组15例．男10例,女5例．年龄12—67岁。C1,2椎体结核3例．Hangman 7例,先天性齿状突不连伴难复性环椎脱位3例,齿状突骨折2例。本组经高位前方咽后入路显露C2-3,椎体结核患者行病灶清除术．先天性齿状突不连者行前路松解复位．后路环枢融合;Hangman骨折。复位后行C2,3椎间植骨融合术．放自锁钛板内固定,齿状突骨折行前路中空螺钉内固定。结果15例患者均成功地显露C1前弓至C3椎体,并完成病灶清除、复位、减压融合内固定：无颈部重要血管神经损伤,无伤口感染．9例不全瘫有部分恢复。结论高位前方咽后入路可充分显露上颈椎．高位颈椎前路术式能有效复位、减压和稳定,并可最大程度重建颈椎生理功能。     

One‐stage anterior release and reduction with posterior fusion for treatment of irreducible atlantoaxial dislocation

Objective: To analyze the approach and feasibility of one‐stage anterior release and reduction with posterior fusion for irreducible atlantoaxial dislocation. Methods: Ten male and 6 female patients, with an average age of 36 years, including 13 patients with old trauma, 2 with rheumatoid disease, and 1 with os odontoideum were studied. Anterior release and reduction was performed in the supine position. The atlas and vertebra dentate were fixed posteriorly and fused by one stage. Results: All patients were followed up from 15 to 40 months (mean, 23 months), and all gained anatomic reduction and bone fusion. Six months postoperatively, the Japanese Orthopaedic Association (JOA) score of the 12 patients with cord symptoms had improved from 8.3 preoperatively to 13.9, with a mean improvement of 87.5%. Conclusion: Treatment of irreducible atlantoaxial dislocation with one‐stage anterior release and reduction with posterior fusion is a reliable method.     

Os odontoideum with bipartite atlas and segmental instability: a case report

We report on the case of a 15-year-old adolescent who presented with a transient paraplegia and hyposensibility of the upper extremities after sustaining a minor hyperflexion trauma to the cervical spine. Neuroimaging studies revealed atlantoaxial dislocation and ventral compression of the rostral spinal cord with increased cord signal at C1/C2 levels caused by an os odontoideum, as well as anterior and posterior arch defects of the atlas. The patient underwent closed reduction and posterior atlantoaxial fusion. We describe the association of an acquired instability secondary to an os odontoideum with an anteroposterior spondyloschisis of the atlas and its functional result after 12 months. The rare coincidence of both lesions indicates a multiple malformation of the upper cervical spine and supports the theory of an embryologic genesis of os odontoideum.

     

Transoral anterior revision surgeries for basilar invagination with irreducible atlantoaxial dislocation after posterior decompression: a retrospective study of 30 cases

Purpose

To report the surgical techniques and clinical results of one-stage transoral anterior revision surgeries for basilar invagination (BI) with atlantoaxial dislocation (AAD) after posterior decompression.

Methods

From September 2008 to June 2012, 30 patients (16 men and 14 women) who had BI with irreducible atlantoaxial dislocation (IAAD) after posterior decompression underwent anterior revision surgeries in our department. Dynamic cervical radiographs, computed tomographic scans and magnetic resonance imaging were obtained pre- and postoperatively to assess the degree of AAD and ventral compression on the cervical cord. The JOA scoring system was used to evaluate the neurological status. The revision surgeries were conducted by anterior approach, using the transoral atlantoaxial reduction plate (TARP) system.

Results

The revision surgeries were successfully performed in all of the cases. The average follow-up duration was 16 months (range 6–39 months). For all of the cases, complete or more than 50 % reduction and decompression of C1–C2 were achieved. The cervicomedullary angle was improved by an average of 32.9°. Bone fusion was achieved within 3–6 months in all of the cases. Clinical symptoms were alleviated in 29 patients (96.7 %) and stabilised in 1 patient (3.3 %). No patients have developed recurrent or progressive atlantoaxial instability so far.

Conclusion

Anterior revision surgeries using the TARP system achieved reduction, decompression and fixation of C1–C2 in one stage for BI with IAAD. This technique offers an effective, simple and safe method for the revision of such cases after posterior decompression.     

寰椎后弓椎板钩联合枢椎椎弓根螺钉固定治疗游离齿状突并可复性寰枢椎脱位

背景：游离齿状突并可复性寰枢椎脱位常需要手术治疗,但目前缺乏操作简单且安全有效的寰枢椎内固定方式。 目的：评估寰椎后弓椎板钩联合枢椎椎弓根螺钉固定植骨融合治疗游离齿状突并可复性寰枢椎脱位的疗效。 方法：回顾性分析2005年7月至2012年6月采用寰椎后弓椎板钩联合枢椎椎弓根螺钉固定自体髂骨植骨融合术治疗游离齿状突并可复性寰枢椎脱位患者l1例。对脱位复位情况、内固定植骨融合率、JOA功能评分、影像学评估及术后并发症等进行分析。 结果：11例术中均未发生椎动脉和脊髓损伤。术后均获得随访,随访时间为12~37个月,平均25个月,均未发生内固定物松动、断裂,术后疼痛和神经症状均得到缓解,术后JOA评分较术前明显改善（P＜0.01）,寰枢椎均融合。 结论：寰椎后弓椎板钩联合枢椎椎弓根螺钉固定植骨融合术治疗游离齿状突并可复性寰枢椎脱位是一种安全有效的方法。     

Posterior atlantoaxial subluxation due to os odontoideum combined with cervical spondylotic myelopathy : a case report

In patients with os odontoideum and posterior atlantoaxial subluxation are extremely rare. No reports have described posterior atlantoaxial subluxation associated with os odontoideum combined with cervical spondylotic canal stenosis, both of which require surgical treatment. We report one case of a 75-year-old female who underwent arthrodesis between the occiput and C3 using a hook-and-rod system and also a double-door laminoplasty from levels C3 to C7. The claw mechanism was applied between the C2 lamina and the C3 inferior articular process. The posterior atlantoaxial subluxation was completely reduced by the method that the rod gradually pushed the posterior arch of C1 anteriorly during connection to the occiput. Twelve months after surgery, the patient showed improvement in preoperative clumsiness and gait disturbance, and the latest plain radiographs showed solid osseous fusion, with no loss of correction or instrumentation failure.

     

游离齿状突并发寰枢关节脱位的治疗策略及疗效分析

目的:探讨游离齿状突并发寰枢关节脱位的治疗策略并观察其临床疗效.方法:回顾性分析2006年1月至2015年1月手术治疗的17例齿状突游离小骨并发寰枢关节脱位患者的相关资料,其中男7例,女10例;年龄17～53(43.1±11.3)岁;病程3～27(10.2±6.9)个月.所有患者术前予颅骨牵引,14例可复性脱位患者中1...     

Transoral-transpharyngeal approach to the anterior craniocervical junction. Ten-year experience with 72 patients

The anterior transoral-transpharyngeal operation to correct ventral irreducible compression of the cervicomedullary junction was utilized in 72 individuals. The patients' ages ranged from 6 to 82 years, and 29 were children. The pathology encountered was primary basilar invagination, rheumatoid irreducible cranial settling, secondary basilar invagination due to migration of odontoid fracture fragments, dystopic os odontoideum, granulation masses, clivus chordoma, osteoblastoma, and chondroma of the atlas. Fifteen patients had associated Chiari malformation with basilar invagination. Fifty-two patients required subsequent atlantoaxial or occipitocervical fusion. Neurological improvement was the rule. There were two deaths within 30 days of surgery: one from myocardial infarction 4 weeks after surgery and one from Gram-negative septicemia of urinary tract origin. There was one pharyngeal wound infection. The ventral transoral approach provides a safe, rapid, and effective means for decompression of the abnormal craniovertebral junction.     

难复性寰枢关节脱位的手术治疗

目的探讨难复性寰枢关节脱位的手术治疗方法。方法54例难复性寰枢关节脱位患者,男32例,女22例;年龄7～63岁,平均32岁。其中齿突不连18例,寰椎枕骨化畸形22例,齿突骨折畸形愈合5例,寰椎横韧带松弛9例。40例有脊髓病或脊髓损伤的症状、体征。先行经口咽入路的寰枢关节松解复位术,术中横断挛缩的椎前肌、前纵韧带和侧块关节囊,借助于牵引和器械撬拨的力量使寰枢关节复位;同期行后路寰枢或枕颈固定植骨融合术,后路固定方法包括经寰枢侧块关节螺钉固定5例、寰枢侧块钉板固定12例和借助于枢椎椎弓根螺钉与枕颈固定板的枕颈固定37例。术后不用外固定。结果41例获得解剖复位;13例部分复位,其中2例行部分齿突切除,另11例术前颈髓角平均104.1°,术后120.2°。48例随访4～40个月,平均15.7个月,全部病例均获骨性融合。术前有脊髓症状的38例术后功能评价(Odom标准)为优15例,良14例,可8例,差1例。术中出现硬膜破裂1例,椎弓根钉切割1例;术后出现呼吸衰竭1例,发音不正常3例,吞咽不利1例,术后2周发生败血症脊髓炎致瘫痪1例,术后2个月内固定松动1例。结论经口咽入路寰枢关节松解复位结合后路坚强内固定及植骨融合,对难复性寰枢关节脱位有良好的治疗效果。