经口咽齿突切除结合H—V环复位治疗重度陈旧性寰枢椎脱位

目的：探讨经口咽齿突切除结合H－V环复位治疗重度陈旧性寰枢椎脱位的方法及重度寰枢椎脱位的病理机制。方法：对2例重度陈旧性寰枢椎脱位患者采用经口咽齿突切除前方松解、减压，结合H－V环缓慢复位，二期行后路减压枕颈融合方法治疗。结果：1例术前Frankel C级恢复至正常，1例术前Frankel C级恢复至D级。结论：重度陈旧性寰枢椎脱位，在寰椎前弓与枢椎体间形成纤维组织增生，这种纤维连接使寰枢椎相对趋向稳定是障碍复位的主要因素。结合H－V环缓慢牵引，复位制动，经口咽入路行齿突切除前方松解减压，二期行后路减压枕颈融合，确能从前后方解除致压因素，结合H－V环制动、复位能够保障复位和手术过程中头颈部的运动在H－V环控制下，对手术和复位提供了极大的安全保证。

Transoral Transpharyngeal Approach with H-V Ring for Severe Old Atlanto-axial Dislocation

Objective: To study the method of transoral transpharyngeal approach with H V ring for old atlas axis dislocation and the patholopy mechanism. Method:2 patients with severe old atlanto axial dislocation have been received transoral anterior relaxation, decompression with H V ring immobilization reduction slowly and through posterior approach their cranio cervica were fused at the second stage. Result: One patient with Frankel C recovered to normal, the other one with Frankel C recovered to D.Conclusion: Severe old altanto axial dislocation, there fibrous tissue hyperplasia between anterior arch of atlas and axis body. This kind of fibrous tissue make atlanto axial tend to stability, which is the mainly factor for disturbance reduction. It truly can remove the compression factor that with H V ring distract slowly, and reduction immobilization, transoral transpharyngeal approach for anterior relaxation, decompression, the dens be cut off, and through posterior approach for cranio cervica fusion. H V ring immobilization can ensure reduction and make the move of head cervical under the control of H V ring, which supply safe guarantee greatly.