后路悬臂梁支撑线缆提拉复位固定治疗可复性及难复性寰枢椎脱位

Cable-dragged reduction/cantilever beam internal fixation and fusion for the treatment of reversible and irreducible atlantoaxial dislocation

中文关键词:  后路  寰枢椎脱位  悬臂梁  线缆提拉复位  疗效

英文关键词:Posterior  Atlantoaxial dislocation  Cantilever beam  Cable dragged reduction  Clinical effect

中文摘要:

  【摘要】 目的：探讨后路悬臂梁支撑线缆提拉复位固定治疗可复性及难复性寰枢椎脱位临床疗效。方法：回顾分析2010年1月至2018年12月收治25例寰枢椎脱位患者资料，其中男15例，女10例，年龄21～72岁，平均49.6±8.8岁。所有病例术前都有不同程度四肢麻木及乏力症状，术前经颈椎动力位片及持续颅骨牵引判定12例为可复性寰枢椎脱位，13例为难复性寰枢椎脱位。25例患者均行后路悬臂梁支撑线缆提拉复位固定融合术。通过术前、术后日本骨科学会（Japanese Othopaedic Associasion，JOA）评分评估神经功能恢复情况，通过术前、术后影像学测量寰齿间距（atlantodental interval，ADI）和延髓脊髓角（cervicomedullary angle，CMA）评估寰枢椎脱位复位情况。结果：所有患者随访12个月～8年，平均随访1年6个月。JOA评分术后1周、6个月及末次随访分别为13.7±1.4、14.8±1.6、15.2±1.3分，较术前9.1±1.5分明显改善（P<0.05）。术后影像学随访提示寰枢椎脱位复位满意，ADI术后1周、6个月及末次随访分别为2.3±0.3mm、2.3±0.5mm、2.4±0.6mm,均较术前（6.5±0.9mm）明显改善（P<0.05）。CMA术后1周、6个月及末次随访分别为153.9°±7.3°、153.4°±7.6°、152.7°±7.8°，均较术前（121.8°±5.1°）明显改善（P<0.05）。1例患者随访发现线缆对寰椎后弓有部分切割，但未断裂。所有病例未见内固定螺钉松动，断裂，骨性融合均良好。结论：后路悬臂梁支撑线缆提拉复位固定治疗可复性及难复性寰枢椎脱位是一种固定牢固，安全可靠的方法，可获得良好的临床效果。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical outcomes of cable-dragged reduction/cantilever beam internal fixation and fusion for the treatment of reversible and irreducible atlantoaxial dislocation. Methods: From January 2010 to December 2018, 25 cases with atlantoaxial dislocation were surgically treated in our hospital，including 15 males and 10 females with an average age of 49.6±8.8(range, 21-72) years old． All patients presented with varying degrees of limb numbness and weakness before surgery. 12 cases were reversible atlantoaxial dislocation, 13 cases were irreducible atlantoaxial dislocation, which were diagnosed by dynamic X-ray of cervical spine and continuous skull traction before surgery. The cable-dragged reduction/cantilever beam internal fixation and fusion was performed on all the patients． Through the preoperative and postoperative JOA score to evaluate nerve functional restoration, atlantodental interval(ADI) and cervicomedullary angle(CMA) which preoperative and postoperative imaging measurements were performed, were used to evaluate the reduction of atlantoaxial dislocation. Results: All patients were followed up for 18 months on an average(range 12-96 months)． JOA scores were 13.7±1.4, 14.8±1.6 and 15.2±1.3 at 1 week, 6 months and final follow-up after surgery, which were significantly improved compared with the preoperative scores 9.1±1.5(P<0.05). The imaging of postoperative follow-up indicated the atlantoaxial dislocation, which achieved satisfactory reduction. ADI were 2.3±0.3mm, 2.3±0.5mm and 2.4±0.6mm at 1 week, 6 months and final follow-up after surgery, which were significantly improved compared with the preoperative 6.5±0.9mm(P<0.05). CMA were 153.9°±7.3°, 153.4°±7.6° and 152.7°±7.8° at 1 week, 6 months and final follow-up after surgery, which were significantly improved compared with the preoperative 121.8°±5.1°(P<0.05). One case was found the cable cut to the posterior arch of atlas which not fractured at follow-up. No internal fixation screw loosening, fracture and all cases achieved good posterior osseous fusion. Conclusions: Cable-dragged reduction/cantilever beam internal fixation and fusion has the advantages of fixed firm, lower risk and satisfactory reduction． It is reliable and effective for reversible and irreducible atlantoaxial dislocation.