一期后路手术治疗可复性寰枢椎脱位合并下颈椎椎管狭窄

One-stage posterior combined surgery for reducible atlantoaxial dislocation with lower cervical spinal canal stenosis

中文关键词:  寰枢椎脱位  可复性  下颈椎椎管狭窄  脊柱融合术  椎板成形术  联合手术

英文关键词:Atlantoaxial dislocation  Reducible  Lower cervical spinal canal stenosis  Spinal fusion  Laminoplasty  Combined surgery

中文摘要:

  【摘要】 目的：探讨一期后路寰枢椎固定融合术联合单开门椎管扩大椎板成形术治疗可复性寰枢椎脱位合并下颈椎椎管狭窄的临床疗效。方法：2010年6月~2017年12月，采用一期后路寰枢椎钉棒系统固定融合术联合单开门椎管扩大椎板成形术治疗寰枢椎脱位合并下颈椎椎管狭窄的患者21例。患者均为可复性寰枢椎脱位，下颈椎椎管狭窄原因包括多节段颈椎间盘突出9例，发育性颈椎管狭窄6例，后纵韧带骨化6例。手术前后和末次随访时采用日本骨科协会（Japanese Orthopaedic Association，JOA）评分对患者神经功能状态进行评估，视觉模拟评分（visual analog scale，VAS）评价枕颈部疼痛程度，测量手术前后寰齿前间隙（atlanto-dental interval，ADI）、下颈椎椎管矢状径（lower cervical sagittal diameter，LCSD）。术后定期复查X线片和CT评价内固定情况、寰枢椎复位状态、植骨融合情况及椎板成形稳定性。结果：21例患者均成功完成手术，术中未出现血管神经损伤。术后1例患者出现手术切口感染，经抗感染、清创后治愈。术后患者神经功能障碍症状及枕颈部疼痛均有不同程度改善，术后及末次随访时的JOA评分、VAS评分、ADI及LCSD与术前比较均有显著性改善（P<0.05）。随访12~45个月（24.9±9.2个月），随访期间X线片、CT示内固定无松动或断裂，寰枢椎脱位无复发，无“再关门”发生，所有患者在术后3~12个月（7.0±2.7个月）获寰枢椎间骨性融合。结论：一期后路寰枢椎固定融合术联合单开门椎管扩大椎板成形术是治疗可复性寰枢椎脱位合并下颈椎椎管狭窄的有效手术方案。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical effect of one-stage posterior atlantoaxial fixation and fusion combined with unilateral open-door laminoplasty in the treatment of atlantoaxial dislocation with lower cervical spinal canal stenosis. Methods: From June 2010 to December 2017, 21 patients with atlantoaxial dislocation and lower cervical spinal canal stenosis were treated in our hospital by one-stage posterior atlantoaxial screw-rod fixation and fusion combined with unilateral open-door laminoplasty. All the 21 patients had reducible atlantoaxial dislocation. The causes of lower spinal canal stenosis included multisegment cervical disc herniation(9 cases), congenital developmental cervical canal stenosis(6 cases), and ossification of posterior longitudinal ligament(6 cases). The Japanese Orthopaedic Association(JOA) score was adopted to estimate the neurologic status, and the visual analog scale(VAS) score was used to evaluate the degree of occipital neck pain. The atlanto-dental interval(ADI) and lower cervical sagittal diameter(LCSD) were measured before and after the operation. X-ray and CT scan were obtained regularly during the follow-up for evaluation of internal fixation, atlantoaxial reduction, bone graft fusion, and stability of laminoplasty. Results: All the 21 patients were successfully operated with no vascular and nerve injury during the operation. Postoperative incision infection occurred in one patient, which was cured by anti-infection and debridement. The neurological dysfunction and occipital neck pain of all patients were improved to different degrees after operation. The JOA score, VAS score, ADI and LCSD were significantly improved after surgery and at final follow-up(P<0.05). The follow-up period was 12-45 months, with an average of 24.9±9.2 months. During the follow-up period, X-ray and CT scan showed no loosening or fracture of internal fixation, no atlantoaxial redislocation, and no "reclosed-door". All patients obtained atlantoaxial bony fusion in 3-12 months after surgery (an average of 7.0±2.7 months). Conclusions: One-stage posterior atlantoaxial fixation and fusion combined with unilateral open-door laminoplasty is an effective surgical procedure for the treatment of the reducible atlantoaxial dislocation with lower cervical spinal canal stenosis.