全麻下颅骨牵引在寰枢椎脱位手术选择中的价值

The value of cranial traction under general anesthesia in surgical selection for the atlantoaxial dislocation

中文关键词:  寰枢椎脱位  颅骨牵引  术式选择

英文关键词:Atlantoaxial dislocation  Cranial traction  Operative selection

中文摘要:

  【摘要】 目的：评价全麻下颅骨牵引指导寰枢椎脱位手术选择的可行性。方法：回顾分析2008年1月～2015年12月在我院诊断寰枢椎脱位行手术治疗的26例患者，男18例，女8例，年龄18～65岁（45.0±5.6岁）。26例均在术中全麻状态下行颅骨牵引，牵引下评估为可复位者通过预弯固定棒、寰枢侧块关节松解、撑开固定等辅助下行单纯经后路固定融合术，评估为不可复位者一期经口咽松解联合后路复位固定融合术。手术前后测量寰齿前间隙（ADI）及斜坡枢椎角评估复位情况，日本骨科学会（Japanese Orthopaedic Association，JOA）评分及颈部功能障碍指数（neck disability index，NDI）评估功能改善情况，Symon临床标准评估疗效。结果：26例患者在全麻颅骨牵引下评估为可复位23例（88.5％），行单纯经后路固定融合术；评估为不可复位3例（11.5％），行一期经口咽松解联合后路复位固定融合术。患者均顺利完成手术，均获得随访，随访时间6个月～8年（25.3±6.3个月）。术前与术后末次随访时的ADI、斜坡枢椎角、JOA评分、NDI分别为：7.4±1.5mm、121.3°±5.1°、8.0±0.9分、36.6±3.0，2.1±0.9mm、143.7°±6.2°、14.1±1.6分、15.7±5.6；末次随访时均较术前明显改善（P＜0.05）。末次随访时Symon临床标准评估有效（改善1级）12例，显效（改善2级）13例，无效1例，有效率96％，显效率50％。结论：根据全麻下颅骨牵引后寰枢椎脱位复位情况选择单纯后路固定或者联合前路松解手术方式可以取得良好的临床效果。

英文摘要:

  【Abstract】 Objectives: To evaluate the feasibility of cranial traction under general anesthesia in surgical selection of atlantoaxial dislocation. Methods: Twenty-six patenits with atlantoaxial dislocation were treated from January 2008 to December 2015, including 18 males and 8 females, aging from 18 to 65 years with an average age of 45.0±5.6 years. All cases applied cranial traction after general anesthesia. After traction, patients who got reduction underwent posterior fixation and fusion, including atlantoaxial facet joint release, stick pre-bending, fixation distracting and so on. Patients who did not get reduction underwent transoral release combined with posterior fixation. Before and after operation the change of atlantodental interval(ADI) and clivus-axial angle were applied to evaluate the reduction. The change of JOA score and NDI score were applied to evaluate the symptom improvement before and after operation. Symon clinical standard was used to assessed total response after operation. Results: All the 26 patients were succesfully operated, among them 23 cases(88.5％) underwent posterior fixation and fusion, 3 cases(11.5％ ) who did not get reduction underwent aschose transoral release combined with posterior fixation and fusion. All patients were followed up from 6 months to 8 years(average, 25.3±6.3 months). The mean ADI, clivus-axial angle, JOA score and NDI score before and after operation were 7.4±1.5mm, 121.3°±5.1°, 8.0±0.9, 36.6±3.0 and 2.1±0.9mm, 143.7°±6.2°, 14.1±1.6, 15.7±5.6. The ADI, clivus-axial angle, JOA score and NDI score significantly improved compared to those before operation(P<0.05). Symon clinical standard got an effective rate of 96％ and excellence rate of 50％ at last follow-up. Conclusions: According to the reduction of atlantoaxial dislocation after cranial traction under general anaesthesia, choosing posterior fixation or anterior release combined with posterior approach can achieve good clinical efficacy.