Magerl技术联合单侧椎板夹固定融合术治疗可复性寰枢椎脱位的疗效

The efficacy of the Magerl technique combined with unilateral laminar clamp instrumentation for reducible atlantoaxial dislocation

中文关键词:  寰枢椎脱位  内固定  脊柱融合术

英文关键词:Atlantoaxial dislocation  Internal fixators  Spinal fusion

中文摘要:

  【摘要】 目的：评价后路经寰枢椎侧块关节螺钉（Magerl技术）联合单侧椎板夹固定融合术治疗可复性寰枢椎脱位的早中期临床疗效。方法：2004年5月~2010年12月对8例可复性寰枢椎脱位患者采用Magerl技术联合单侧椎板夹固定融合术治疗，其中男6例，女2例；年龄35～63岁，平均41.6岁。急性外伤性脱位2例，陈旧外伤性脱位3例，先天性畸形致脱位3例。术前枕颈部疼痛5例，斜颈4例，有高位脊髓受压症状5例。术前脊髓功能Frankel分级：D级5例，E级3例。术前动力位X线片显示寰枢椎不能复位者3例，行常规颅骨牵引，隔日行床旁X线片检查显示，1例获得复位，2例纵向牵引至最大重量仍复位不佳，再换成双向牵引，复位满意后再行手术治疗。均采用UCSS螺钉进行Magerl手术；4例同时采用Apofix椎板夹固定，4例同时采用Vertex椎板夹固定。结果：手术时间75～160min，平均106min；术中出血量80～550ml，平均200ml。术中和术后无脑脊液漏发生，无神经损伤加重；术后切口延迟愈合1例。术后颈痛、斜颈消失；5例术前Frankel分级D级患者中，术后2例恢复至E级，3例仍为D级。随访10～35个月，平均16.8个月。所有患者均获骨性融合，融合时间为4~8个月，平均5.6±0.5个月。随访期间无螺钉断裂和椎板夹松脱。结论：对可复性寰枢椎脱位患者采用Magerl技术联合单侧椎板夹固定融合术，操作相对简单，早中期疗效较满意。

英文摘要:

  【Abstract】 Objectives: To evaluate the early-middle stage clinical efficacy of posterior atlantoaxial facet screw(Magerl technique) combined with unilateral laminar clamp instrumentation for reducible atlantoaxial dislocation. Methods: From May 2004 to December 2010, 8 cases with reducible atlantoaxial dislocation underwent the combination of Magerl technique and unilateral laminar clamp instrumentation. There were 6 males and 2 females with an average age of 41.6 years old(range, 35 to 63 years). The pathogenesis included 2 acute traumatic dislocations, 3 old traumatic dislocations and 3 dislocations due to congenital deformity. The preoperative symptoms included occipital-cervical pain in 5 cases, torticollis in 4 cases and high level spinal cord compression in 5 cases. Preoperative spinal cord function evaluated by Frankel classifications was showed as following: Frankel D in 5 cases and Frankel E in 3 cases. 3 irreducible cases were subject to preoperative skull traction, and X-ray was taken every 2 days. 1 case achieved reduction after one-direction skull traction, while two cases underwent two-direction traction due to irresponsible to one-direction traction with maximal weight. The operations were performed after good reduction of C1-2. The UCSS screws by Margel technique were used in all cases together with Apofix and Vertex laminar clamps in 4 patients respectively. The perioperative and follow-up indexes included operation time, intraoperative blood loss, postoperative neurologic function and intra-/postoperative complications. Results: The average operation time was 106min(range, 75 to 160min). The average intraoperative blood loss was 200ml(range, 80 to 550ml). No cerebrospinal fluid leakage or neurological deficit was noted. Delayed healing of skin incision was noted in 1 case. All patients had neck pain and torticollis relieved after operation, and of 5 cases with preoperative Frankel D, 2 cases recovered to Frankel E while 3 cases remained unchanged. The average follow-up was 16.8 months(range, 10-35 months). Bone fusions were achieved in all patients with the average time of fusion of 5.6±0.5 months(range, 4-8 months). No instrument failure was noted during follow-up. Conclusions: For reducible C1-2 dislocation, Magerl technique combined with unilateral laminar clamp instrumentation is simple and reliable for early and middle stage.