对经颈侧方入路行脊髓腹侧减压治疗寰枢关节前脱位的评价

目的：对经颈侧方入路行脊髓腹侧减压治疗寰枢关节前脱位的手术方法进行评估。方法：9例难复性寰枢关节前脱位患者采用经颈侧方入路进行脊髓腹侧减压，术前未做枕颈融合或融合失败的患者在术后2～6周进行枕颈融合术，对脊髓腹侧减压术中情况进行总结和术后效果进行随访，并复查颈椎CT和MRI。结果：手术时间平均7h．平均出血量2300ml；椎动脉损伤3例；舌下神经损伤3例。9例患者术后早期均无明显效果，3例6个月后出现改善，其中2例效果明显；6例无效，其中1例术后6个月北于长期卧床并发症，1例在术后1年冉次行经口咽入路脊髓减压手术，北于蛛网膜下腔感染。结论：经颈侧方入路进行脊髓腹侧减压治疗寰枢关节前脱位显露困难，减胀不充分，并发症多．不宜采用。

The results of lateral approach to upper cervical spine for decompression of atlantoaxial dislocation

Objective:To evaluate the result of lateral approach to upper cervical spine for decompression of atlantoaxial dislocation.Method:9 cases with irreducible anterior atlantoaxial dislocation were decompressed through lateral approach.The cases with unsuccessful previous craniocervical fusion or without the fusion underwent the fusion 2 to 6 weeks later.The decompression course was recorded in detail,CT and MRI before and after the operaion were taken and neurologic function was followed up.Result:This approach was not satisfactory because of more bleeding,long duration of operation,difficulty to access to the field of decompression,vague anatomic exposure.The vertebral artery and hypoglossal nerve were injuried in separated 3 cases during operation.In no cases had obvious neurologic changes at early postoperative time,3 cases improved 4 monthes later.Among 6 no change cases,1 died of the complications of long bed time and 1 died of infection in another transoral decompression.Conclusion:The lateral approach to upper cervical spine for decompression of atlantoaxial dislocation offers poor exposure and unsufficient decompression.