经口咽前路减压侧块关节融合器植骨融合联合颈椎压力固定器治疗难复性寰枢椎脱位

Clinical study of use of transoralatlantoaxial lateral joint cage plus mini compressive cervical frame fixation for the treatment of irreducible atlantoaxial dislocation

中文关键词:  寰枢椎脱位  寰枢关节  融合器  颈椎压力固定器

英文关键词:Irreducible atlantoaxial dislocation  Atlanto-axial joint  Cage  C-JAWS

中文摘要:

  【摘要】 目的：探讨经口咽前路减压侧块关节融合器（cage）植骨融合联合颈椎压力固定器（mini compressive cervical frame/C-JAWS）内固定术治疗难复性寰枢椎脱位的临床初步应用效果。方法：应用经口咽前路减压侧块关节cage植骨融合联合C-JAWS内固定术治疗难复性寰枢椎脱位患者14例，包括单纯难复性寰枢椎脱位8例，陈旧性寰枢椎脱位后路术后复发1例，颅底凹陷症伴寰枢椎脱位4例，颅底凹陷症伴寰枢椎脱位枕颈融合术后复发1例。根据美国脊髓损伤学会（ASIA）分级对神经功能进行评估，采用ASIA运动评分进行运动功能评估，术前D级9例，E级5例。术后定期随访X线、CT评价复位、内固定及植骨融合情况。结果：14例患者均成功完成手术，术中未发生神经血管损伤。术后1例患者诉颈部不适，1例患者诉咽喉部异物感，经对症处理后缓解。术后患者枕颈部疼痛和肢体麻木无力症状均不同程度改善。9例术前ASIA分级为D级的患者中3例术后改善为E级，其余6例分级无变化；5例术前分级为E级的患者术后分级无变化。ASIA运动评分由术前68.1±9.7分改善至术后的91.7±6.6分，手术前后比较，差异有统计学意义（t=-17.220，P=0.000）。随访3～24个月，平均12.2±6.8个月，X线片、CT复查示无复发脱位，cage位置满意，C-JAWS固定良好，无松动，均获骨性融合。结论：经口咽前路减压寰枢椎侧块关节cage植骨融合联合C-JAWS内固定术是治疗难复性寰枢椎脱位一种有效的、可选择的手术方法。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical use of transoralatlantoaxial lateral joint cage plus mini compressive cervical frame(C-JAWS) fixation for the treatment of irreducible atlantoaxial dislocation. Methods: Fourteen patients with irreducible atlantoaxial dislocation, including eight irreducible atlantoaxial dislocation, one old atlantoaxial dislocation after posterior procedure, four basilar invagination and one basilar invagination after posterior occipitocervical fusionwere treated with transoralatlantoaxial lateral joint cage implantation and C-JAWS fixation. American Spinal Cord Injury Association(ASIA) were used to evaluate the surgical outcome. Before operation, 9 patients were in grade D, and 5 cases were in grade E. Patients were followed up and performed X-ray and CT to estimate reduction, fixation, and fusion. Results: All operations were successfully performed without neurovascular injury. After operation, 1 patient with neck discomfort and 1 case with foreign body sensation in throat relieved after correspondent treatment. The incidence of neck pain and extremity anesthesia or asthenia of all cases decreased in different degree. According to ASIA grading system, 9 cases were in grade D, 3 cases improved from D to E after surgery, and other six cases remained no change postoperatively. 5 cases with E grade preoperatively got no change postoperatively. ASIA motor score improved from preoperative 68.1±9.7 to 91.7±6.6 after the surgery, the difference had statistical significance(t=-17.220, P=0.000). The patients were followed up for 3 to 18 months (average, 12.2±6.8 months). Solid bony fusion and no instrument displacement was found on X-ray and CT. Conclusions: Transoralatlantoaxial lateral joint cage fusion and C-JAWS fixation procedure is a effective and selectable surgical method for treating of irreducible atlantoaxial dislocation.