经口咽前路松解复位重建钢板内固定治疗难复性寰枢椎脱位初步疗效观察

目的：探讨经口咽前路松解复位重建钢板固定植骨融合治疗难复性寰枢椎脱位的可行性、安全性及初步疗效。方法：应用经口咽松解复位重建钢板固定植骨融合术治疗难复性寰枢椎脱位9例。其中陈旧性齿状突骨折4例，陈旧性寰枢关节脱位3例，先天性游离齿突2例。9例患者均有脊髓病或脊髓损伤表现。术后观察患者症状、体征及脊髓功能，并行X线、CT三维扫描和MRI检查。结果：9例患者平均随访11（8-30）个月。按JOA评分法和影像学脊髓受压评定标准，颈椎JOA脊髓功能评分平均10.6±2.95，MRI寰枢椎的受压指数平均为0.67，脊髓功能改善率平均为76.8％。无内固定松动、断裂、再脱位，3-6个月均骨性融合。MRI显示，术后即刻脊髓减压改善率91.2％，终访时改善率为92.8％。1例术后发生严重的15疱疹经治痊愈，2例出现一过性枕颈部疼痛，对症治疗后缓解。无脊髓神经、血管损伤及感染等并发症。结论：经口咽前路松解重建钢板复位固定一期植骨融合治疗难复性寰枢关节脱位手术方法安全，复位固定可靠，近期临床疗效明显。

The Treatment of Irreducible Atlantoaxial Dislocation by Transoral Release,Reduction, Bone Fusion and Instrumentation

Objective： To investigate the feasibility, security and primary clinical results of the transoral release, reduction, bone fusion and instrumentation for treating the irreducible atlantoaxial dislocation. Methods：Nine patients of irreducible atlantoaxial dislocation with myelopathy or spinal injury, including 4 cases of obsolete fractures of odontoid process, 3 oboslete atlantoaxial dislocation, 2 congenital free odontoid bone, received transoral release, reduction, bone fusion and fixation with nickelclads. The postoperative symptoms, physical signs and function of spinal cord were recorded. Meanwhile, X-rays, three dimensions computed tomography （3D-CT） and magnetic resonance imaging （MRI） were performed on these patients. Results： All the pateints had been followed up for 11（8-30） months. According to the evaluated criteria of spinal compression by JOA score and imaging, the preoperative mean score of spinal function was 10.6±2.95, the postoperative was 14.8±1.9, the index of atlantoaxial compression was 0.67. The mean improvement rate of spinal compression was 76.8%. During the follow up period, we did not observe the screwes loosening, breaking and redislocation. A stable fusion of C1/2 was found in 3-6 months. The immediate improvement rate of spinal com- pression was 91.2%, at the end of follow up period, it was 92.8%. Herpes labialis happened in one case was cured well. Transient severe oecipitocervical pain was complained by two cases, who accepted symptomatic treatments and their pain were relieved. No complications such as damages to spinal nerves and blood vessels and postoperative infection were observed. Conclusions：The procedures of transoral release, reduction, bone fusion and instrumentation for treating irreducible atlantoaxial dislocation is safe, reliable and stable, with good primary clinical results.