摘要
目的探讨经皮显微脊柱内窥镜(MED)下松解、复位和寰枢椎(C_(1、2))侧块螺钉内固定植骨融合治疗难复性 C_(1、2)关节脱位的可行性和安全性。方法 8例患者中齿突发育不良3例,陈旧性齿突骨折2例,先天性齿突缺如、颅底凹陷症和齿突不连各1例。按 Symon 和 Lavender 临床标准评定中型4例,重型3例,特重型1例,施行经皮 MED 下 C_(1、2)前间隙松解、复位、侧块螺钉固定和植骨融合术。结果 8例难复性寰枢椎关节脱位7例完全复位,1例部分复位。全部采用经皮前路 C_(1、2)侧块螺钉固定,位置良好,平均手术时间120 min(90～150 min),出血量150 ml(100～250 ml)。随访8～16个月,总有效率100%,显效率51.25%;椎管减压平均改善率76.5%。无内固定断裂与松脱,骨性愈合,颈部旋转受限30°～40°。结论 MED 下 C_(1、2)前间隙松解、复位、侧块螺钉固定和植骨融合治疗寰枢椎关节脱位,达到传统开放手术要求,此技术安全有效。
Objective To evaluate the safety and efficacy of one-stage percutaneous microendoscopic anterior release, transarticular fixation and fusion to reduce and stabilize for irreducible atlanto-axial dislocation. Methods Eight consecutive patients were treated by pereutaneous microendoscopic anterior release, transarticular C1、2 fixation and bone graft fusion. The mean age was 33 years （range, 28-52 years）. The pathology included odontoid dysplasia in 3 patients, chronic odontoid fractures in 2, odontoid absence in 1, fasilar impression in 1 and malunion of odontoid fracture in 1. The classification of disability was that proposed by Symon and Lavender. There were moderate disability in 4, severe non-bedbound in 3, and severe bedridden in 1. Results The new technique was performed successfully in all cases. All patients underwent transarticular C1、2 screw fixation and anterior bone graft fusion. The average operation time was 120 min （90-150 min） , and the average estimated blood loss was 150 ml （100-250 ml）. Seven cases resulted in anatomic reduction, 1 had partial reduction. The follow-up period was 8-16 months. The effective rate was 100%, and the excellent rate was 51.25% ; the average improvement rate for the spinal canal decompression was 76. 5%. There was no instrument failure or pseudarthrosis, and solid fusion was achieved in the all cases. The loss of axial rotation of cervical spine was 30-40°. Conclusion Percutaneous microendoscopic anterior release, fixation and fusion is an effective, reliable, and safe procedure for the treatment of irreducible atlanto-axial dislocation.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2007年第6期383-386,共4页
Chinese Journal of Surgery
关键词
寰椎
枢椎
融合
前路松解
复位
Atlas
Axis
Fusion
Anterior release
Reduction
