经口前路寰枢椎复位钢板系统治疗先天性枕颈交界区畸形

目的探讨经口前路寰枢椎复位钢板（transoral atlantoaxial reduction plate,TARP）系统用于先天性枕颈交界区畸形手术治疗的临床疗效。方法 2007年12月-2011年12月采用TARP系统治疗先天性枕颈交界区畸形患者35例。所有患者术前术后均行颈椎过伸过屈位X线、枕颈交界区CT扫描及MRI以评估局部畸形及颈脊髓腹侧压迫情况;采用日本骨科学会（Japanese Orthopaedic Association,JOA）评分（17分法）评估术前术后脊髓损伤及恢复情况。术后3、6、12个月复查颈椎正侧位X线片及CT,评价内固定效果及融合情况。结果 35例患者均顺利完成手术,术后MRI示颈脊髓腹侧压迫均有明显减轻,延髓脊髓角术后平均增加约29.7°,31例（89%）患者术后神经功能有明显改善,4例术前术后神经功能无变化。术后随访1年未发现寰枢椎再脱位、螺钉松动、断裂或移位等并发症。结论TARP系统可对先天性枕颈交界区畸形合并腹侧颈脊髓压迫进行一期减压、复位及内固定,是枕颈交界区畸形理想的治疗手段之一。

Transoral atlantoaxial reduction plate system for treatment of craniovertebral junction deformities

Objective To investigate the curative effect of the transoral atlantoaxial reduction plate (TARP)system for treatment of craniovertebral junction deformities. Methods From December 2007 to December 2011, 35 patients with craniovertebral junction deformities with/without atlantoaxial dislocation underwent anterior surgeries using TARP system. Dynamic cervical radiographs, CT scans and MRI were performed pre- and postoperatively to assess the deformities of craniovertebral junction and ventral compression on the cervical cord. The Japanese Orthopaedic Association (JOA)score system was used to evaluate the neurological status. Results All patients were successfully performed the anterior treatment. Ventral decompression of all cases were alleviated and the cervicomedullary angle was improved by averagely 29.7°. The neurological fuctions were improved in 31 patients (89%) and no deterioration in 4 patients(11%) after operation. Conclusion The anterior treatment with TARP system can achieve reduction, decompression and internal fixation for craniovertebral junction deformities with/without atlantoaxial dislocation.