Magerl技术联合单椎板夹固定治疗寰枢椎脱位的远期疗效

 目的评价Magerl技术联合单椎板夹固定治疗寰枢椎脱位的远期临床疗效。方法回顾性分析11例采用Magerl技术联合单椎板夹固定治疗寰枢椎脱位患者的病历资料,依据Symon和Lavender临床功能评定标准、日本矫形外科协会（Japanese Orthopaedic Association,JOA）脊髓功能评分以及影像学测量寰齿前间隙（atlas-dens interval,ADI）和脊髓有效空间（space available for the cord,SAC）评价临床疗效,并观察手术并发症发生情况及植骨融合效果。结果所有患者均获得随访,随访时间48~128个月,平均（67.8±65.3）个月。均获得骨性融合,无内固定断裂发生,无神经损伤、切口感染等并发症。根据Symon和Lavender 临床功能评定标准,末次随访时临床功能改善率为90.9%。按JOA评分末次随访较术前提高（7.0±3.3）分,改善率为86.4%,差异有统计学意义。术后1个月SAC较术前平均增加（7.29±3.06） mm,差异有统计学意义;末次随访时（16.91±0.51） mm,与术后1个月时比较差异无统计学意义。术后1个月ADI较术前平均减少（4.51±1.46） mm,差异有统计学意义;末次随访时 ADI为（2.02±0.18） mm,与术后1个月时比较未见明显丢失。结论Magerl技术联合单椎板夹固定治疗寰枢椎脱位远期效果满意,能提供可靠的生物力学稳定性且植骨融合率高;但须严格掌握适应证,术前通过牵引逐步使寰枢椎完全复位,术中应操作规范避免并发症发生。

The long-term results of Magerl technique combined with single laminar clamp internal fixation in management of atlantoaxial dislocation

ObjectiveTo evaluate the long-term outcomes of Magerl technique combined with single laminar clamp internal fixation in management of atlantoaxial dislocation. MethodsA retrospective study included 11 patients with atlantoaxial dislocation, who were treated with Magerl technique combined with single laminar clamp internal fixation and bone fusion after preoperative traction and reduction. Postoperative complications and efficacy were observed subsequently. The clinical and radiological outcomes were evaluated according to the Symonand Lavender clinical standard, the spinal function score of Japanese Orthopaedic Association (JOA), the imaging index space available for the cord (SAC), and the atlas-dens interval (ADI). The status of bony fusion was also evaluated according to radiological investigation. ResultsThe mean operating time was 101±66 mins (range, 72-160 mins), and the mean bleeding during operation was180±395 ml (range, 70-550 ml). All the patients achieved bone fusion. There was no neurological damage, wound infection or other serious complications. Only one patient showed delayed healing of incision, who was treated successfully with debridement and re-suturing. All the patients were followed up successfully with an average of 67.8±65.3 months (range, 48-128 months), and there were no breakage of screws or laminar clamps. According to the Symonand Lavender clinical standard, the clinical recovery rate was 90.9%. According to the JOA score, there was a significant difference between the preoperative JOA score and the final follow-up, which increased by 7.0±3.3 points with an average recovery rate of 86.4%. The SAC of C_1,2 segment increased by 7.29 mm at one month postoperatively, which showed a significant difference compared with preoperative SAC. The SAC at the final follow-up was 16.91±0.51 mm, which showed no significant difference compared with that at one month postoperatively. The ADI at one month postoperatively decreased by 4.51±1.46 mm, which showed a significant difference compared with preoperative SAC. The ADI at the final follow-up was 2.02±0.18 mm, which showed no significant difference compared with that at one month postoperatively. ConclusionMagerl technique combined with single laminar clamp internal fixation in management of atlantoaxial dislocation showed good long-term results. Magerl technique combined with single laminar clamp internal fixation is one of the alternatives in the treatment of atlantoaxial dislocation, which can provide reliable biomechanical stability and high fusion rate.