寰枢椎脱位的外科分型及其处理对策

目的:寻找一种概念明确的寰枢椎脱位的外科分型方法,为临床处理脱位提供指导方案。方法:总结三家医院收治的168例不同病因所致C1-2脱位患者的临床资料,根据脱位的复位情况将其分为3型:(1)牵引复位型(tractionreductiontype,T型),该型又以复位后的稳定性不同分为T1和T2型;(2)手术复位型(operationreductiontype,O型);(3)不可复位型(irreducibletype,I型)。简称TOI分型。T1型采用牵引或支具治疗8～10周;T2型采用牵引复位后固定融合(其中6例只行C1-2临时固定,不行融合);O型采用前路松解 后路复位固定融合;I型实施减压原位固定融合。根据Symon和Lavender临床标准、JOA脊髓功能评定标准和影像学测量C1-2脊髓有效空间(spaceavailableforthecord,SAC)进行疗效评定。结果:168例中,T型137例(81%),其中T1型71例(43%),T2型66例(38%);O型28例(17%);I型3例(2%)。术前SAC为3～13mm,平均8mm,术后为11～19mm,平均16mm。术后脊髓功能改善率平均为64.7%;临床有效率为88.7%。T型病例中77例未融合固定者愈合后仍保留C1-2活动功能。结论:寰枢椎脱位的TOI外科分型概念清楚,界定明确,可根据分型选择相应的寰枢椎脱位处理方式。

The pilot study of clinical classification for atlantoaxial dislocation

Objective:To explore a definitive clinical classification method of atlantoaxial dislocation and offer therapeutic regimen with strong guidance to the clinic practice.Method:168 cases with C1-2 dislocation due to different causes were grouped into 3 types and 4 subtypes,(1)reduction by traction type,which was termed as the type T and was divided into T1 and T2 subtype based on different cause and course of disease.(2)reduction by operation type,which was termed as the type O;(3)Irreducible type,which was termed as type I.We named this classification as TOI.Therapeutic protocoles were adopted as following,Type T1:applying traction or orthosis for 8-10 weeks,Type T2:reduced by traction followed by C1-2 fusion.Type O:Transoral anterior release followed by posterior fixation.Type I:decompression and fixation in situ.According to Symon and Lavender clinical standard,JOA scoring and SAC imaging index were used to evaluate the therapeutic effect.Result:Among 168 cases,type T had 137 cases(81%),type T1 had 71 cases(43%),type T2 had 66 cases(38%),type O had 28 cases(17%),and type I had 3 cases(2%).The SAC was 3~13mm before operation,averaging 8mm,11~19mm after operation,averaging 16mm.The improving rate of neurological function was 64.7%.Clinical efficient plus excellence rate was 88.7%.Among the cases with type T,there were 77 cases undergoing no fusion of atlantoaxial joint still maintaing the C1-2 joint.Conclusion:TOI clinical classification of atlantoaxial dislocation is definitive,which can give a guidance in the treatment of different C1-2 dislocation.