微创经口咽复位内固定钢板在儿童寰枢椎手术中的初步应用

Primary application of slim transoral anterior reduction plate in pediatric atlantoaxial dislocation through transoral approach

中文关键词:  微创经口咽复位内固定钢板  经口咽手术  寰枢椎脱位  儿童

英文关键词:Slim transoral anterior reduction plate  Transoral approach  Atlantoaxial dislocation  Children

中文摘要:

  【摘要】 目的：探讨微创经口咽复位内固定钢板（slim transoral anterior reduction plate，Slim-TARP）在儿童寰枢椎手术中的临床应用和疗效。方法：２０１５年２月~２０１７年６月应用Slim-TARP内固定治疗8例寰枢椎疾病患者，男4例，女4例；年龄7.2～15.3岁。先天游离齿突合并寰枢椎脱位3例，寰枢椎脱位合并颅底凹陷症3例，寰枢椎旋转脱位2例。经保守治疗无效，行经口咽松解复位Slim-TARP钢板内固定术。观察术中血管损伤和术后切口裂开、吞咽障碍、发音异常、切口感染等并发症，随访观察寰枢椎脱位复位及融合情况，通过JOA评分评价手术疗效。结果：8例患儿手术顺利，未发生术中大出血、椎动脉损伤、脊髓功能损害等严重并发症。随访8~14个月，平均11.5个月。咽后壁切口均顺利愈合，其中1例患儿术后2个月复查发现咽后壁切口附近有息肉样组织增生，予以镜下摘除，恢复良好。未发生切口裂开、感染等并发症，未出现吞咽困难、发音异常等并发症。术后复查颈椎线X线片、CT和MRI显示寰枢椎脱位均获理想复位，术后3~5.5个月获得骨性融合（平均4.4个月）。JOA评分由术前的平均14.4分改善末次随访时的16.6分。结论：应用Slim-TARP内固定治疗儿童寰枢椎脱位安全、有效，并发症少，短期随访疗效满意。

英文摘要:

  【Abstract】 Objectives: To investigate the feasibility and clinical outcomes of slim transoral anterior reduction plate(Slim-TARP) for pediatric atlantoaxial dislocation(AAD) by transoral release and reduction. Methods: From February 2016 to June 2017, 8 pedatric patients(4 females and 4 males), ages ranging from 7.2 to 15.3 yeas old, were included in the study. Among them, there were 3 cases with os odontoid, 3 cases with basilar invagination(BA), and 2 cases of rotationary AAD(RAAD). All the patients underwent TARP opeation (transoral reduction and fixation with plate) after the failure of conservative treatment. The complications such as vertebral artery injury, incision break, infection, dysphonia and dysphagia were recorded. The patients were followed up for 8 to 14 months(average, 11.5 months), AAD reduction and bone fusion were assessed by X-ray, CT and MRI scan images, clinical outcomes were evaluated by JOA scores. Results: All the 8 patients underwent Slim-TARP operation successfully without excessive bleeding, vertebral artery injury, spinal dysfunction or other complications. They were followed up for 8-14 months(average, 11.5 months), all the incisions on pharyngeal wall healed well form the 7th to the 10th day after surgery, except 1 patient who with polypus around the incision on the 3th month postoperatively which was removed by otolaryngologist under endoscopy. There was no incision break, infection, dysphonia or dysphagia. The postoperative X-ray, CT and MRI images showed good reduction in all patients, and solid bone fusion was obtained from 3 to 5.5 months(average, 4.4 months), JOA improved from 14.4 before surgery to 16.6 at the last followed up. Conclusions: The Slim-TARP through transoral approach is feasible in pediatric AAD with less complications and good outcomes.