单纯后路复位及固定治疗自发性寰枢椎脱位

目的 利用单纯后路复位,同时行内固定治疗寰枢椎脱位的方法,既不需要颅骨牵引,也不需经口腔齿状突切除.方法 2004年5月至2007年12月,收治自发性寰枢椎脱位病人20例,手术前后利用CT及MRI进行影像学测量,评价脱位及脊髓延髓受压程度.根据是否合并寰枕融合分别采用C1侧块～C2椎弓根螺钉技术3例及C2椎弓根～枕骨螺钉技术17例.手术中向前推压C2棘突或通过C2椎弓根及枕骨螺钉间撑开将齿状突向前、下牵拉以恢复齿状突与C1前弓的解剖关系.结果 20例病人随访6-48个月,1例术后1周因基底动脉内血栓形成死亡,其余19例均明显改善.手术后影像学检查见脊髓延髓均获彻底减压,合并脊髓空洞的5例病人,空洞均明显缩小;各项影像学测量指标均明显好转(P<0.01).1例于术后3个月时CT提示复位部分丢失,但螺钉位置良好,脊髓延髓减压良好,脊髓空洞继续缩小,6个月时骨性融合.结论 首先选择后路复位及固定,而不是前路经口腔齿状突切除减压,是治疗寰枢椎脱位简单有效,相对安全的方法.

Direct posterior reduction and fixation for the treatment of idiopathic atlantoaxial dislocation

Objective To report our surgical technique and results in the treatment of idiopathic atlantoaxial dislocation (IAAD) by using direct posterior reduction and fixation, without odontoidectomy and cervical traction. Methods Twenty patients of IAAD were operated on during May 2004 to December 2007. Before and after the operation, CT and MRI were used to measure and evaluate the degree of dislocation and neural compression. Two different screw fixation techniques were used depending on whether there was C1 assimilation; C1 lateral mass - C2 pedicle screws fixation was used for patients without C1 assimilation, otherwise, C2 pedicle -Occiput scews fixation was used. Intraoperative reduction was achieved by compressing the C2 spinous process anteriorly, or by distraction between C2 pedicle and occiput screws. Results All 20 patients were followed up from 6 to 48 months, among them, there was one death due to basilar artery thrombosis one week after the operation; in all the other 19 patients, symptoms were relieved markedly. All the postoperative radiological measurements were improved significantly (paired t test, in all groups, P < 0. 01 ). MRI showed good decompression of spinal cord and oblongata medulla in all 19 cases (CMA, P < 0.01 ); in 5 patients associated with Chiari's malformation and syringomyelia, syrinx was significantly shrinked in all patients. Conclusion Using posterior approach and intraoperative reduction and fixation technique, rather than anterior decompression through transoral odontoidectomy, for the treatment of IAAD is an effective, simple and relatively safe method.