| 寰枢椎脱位分型和治疗方案选择的临床观察 |
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Received:December 19, 2015
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| 作者 | Author | 单位 | Unit | E-Mail |
| 宋辉 |
SONG Hui |
西安交通大学第二附属医院骨科, 陕西 西安 710004 |
Department of Orthopaedics, the 2nd Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China |
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| 李浩鹏 |
LI Hao-peng |
西安交通大学第二附属医院骨科, 陕西 西安 710004 |
Department of Orthopaedics, the 2nd Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China |
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| 臧全金 |
ZANG Quan-jin |
西安交通大学第二附属医院骨科, 陕西 西安 710004 |
Department of Orthopaedics, the 2nd Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China |
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| 贺西京 |
HE Xi-jing |
西安交通大学第二附属医院骨科, 陕西 西安 710004 |
Department of Orthopaedics, the 2nd Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China |
xijing_h@vip.tom.com |
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| 期刊信息：《中国骨伤》2016年29卷，第10期，第878-882页 |
| DOI：10.3969/j.issn.1003-0034.2016.10.002 |
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目的：回顾性分析寰枢椎脱位患者手术治疗的方法及效果，探讨一种寰枢椎脱位的临床分型方法及其治疗策略。
方法：分析2005年9月至2013年9月收治的89例寰枢椎脱位患者的临床资料，其中男49例，女40例；年龄13~67岁，平均48.1岁。根据术前颈椎动力位片及术中全麻下大重量颅骨牵引复位情况，将脱位分为3型：易复型（easy reduction type）、难复型（hard reduction type）、不可复型（irreducible type）。易复型寰枢椎脱位经适当复位后采用颈后路固定融合术；难复型寰枢椎脱位经全麻下大重量牵引复位后采用颈后路固定融合术；不可复型寰枢椎脱位选择前路经口松解或减压、后路复位固定融合术。并根据脊髓功能评定标准（JOA）对患者进行疗效评价。
结果：89例患者中易复型寰枢椎脱位30例（33.7%），难复性型55例（61.8%），不可复型4例（4.5%）。JOA评分术前8.2±3.1，末次随访14.2±2.4，改善率40.1%~82.5%，平均62.5%。89例患者均获随访，时间6~37个月，平均17.3个月。82例（92.1%）获得解剖复位，85例（95.5%）获得骨性融合。术后出现低钠血症1例，合并格林巴利综合征1例，伤口延迟愈合4例，1例因呼吸衰竭于术后2年死亡，前路经口手术未见感染病例。
结论：根据术前颈椎动力位片及术中全麻下大重量颅骨牵引复位情况对寰枢椎脱位进行临床分类，并采取相应的治疗策略，具有良好的临床效果。 |
| [关键词]:寰枢椎脱位 分类法 前路松解 后路固定 |
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| Clinical observation on the treatment of atlantoaxial dislocation based on the classification |
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Abstract:
Objective:To retrospectively analyze the surgical methods and its clinical effects and explore a clinical classification and treatment strategy for atlantoaxial dislocation(AAD).
Methods:The clinical data of 89 patients with atlantoaxial dislocation were analyzed from September 2005 to September 2013. There were 49 males and 40 females,aged from 13 to 67 years with an average of 48.1 years. According to the reductive effects with preoperative cervical dynamic radiograph and high weight skeletal traction under general anesthesia,the dislocations were classified into three types:easy reduction type,hard reduction type and irreducible type. The patients with easy reduction type were treated with posterior screw-rod internal fixation after manual reduction,while the patients with hard reduction type were treated with posterior screw-rod fixation after high weight skeletal traction reduction under general anesthesia. The patients with irreducible type were treated with transoral atlantoaxial joint release or depression and posterior internal fixation and fusion. According to JOA scores to evaluate the neurological status and treatment outcome.
Results:Thirty patients were classified as easy reduction type,55 patients as hard reduction type,and 4 patients as irreducible type. The preoperative JOA score was 8.2±3.1 on average,while the postoperative score was 14.2±2.4. The improvement rate was 40.1% to 82.5% with an average of 62.5%. Eighty-nine patients were followed up from 6 to 37 months with a mean of 17.3 months. Eighty-two cases obtained anatomical reduction and 85 cases obtained bony fusion. One case complicated with hyponatremia after operation and 1 case combined with Guillain-Barre syndrome,4 cases complicated with delayed union wounds,1 case died of for respiratory failure 2 years after operation. No wound infections were found in the patients approach for transoral operation.
Conclusion:According to the cervical dynamic radiograph and high weight skeletal traction under general anesthesia to classify for atlantoaxial dislocation,and adopting well strategies to treat the patients,can achieve satisfactory effects. |
| KEYWORDS:Atlantoaxial dislocation Classification Anterior release Posterior fixation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 宋辉,李浩鹏,臧全金,贺西京.寰枢椎脱位分型和治疗方案选择的临床观察[J].中国骨伤,2016,29(10):878~882 |
| 英文格式: | SONG Hui,LI Hao-peng,ZANG Quan-jin,HE Xi-jing.Clinical observation on the treatment of atlantoaxial dislocation based on the classification[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(10):878~882 |
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