摘要
目的探讨寰枢关节间直接撑开技术治疗先天性寰枢椎脱位(CAAD)的安全性和有效性。方法回顾性分析17例采用寰枢关节间直接撑开技术治疗CAAD病人的临床及影像学资料。通过测量病人手术前后寰齿间隙(ADI)、延髓脊髓角(CMA)进行影像学评估,通过日本骨科协会改良脊髓功能评分(m JOA)进行神经功能性评估,并对上述数据结果进行统计学分析。结果术后病人临床症状明显改善16例,改善不佳1例;无死亡及感染病例。术后两周复查CT及MRI,病人ADI值由术前的(5.1±1.4) mm下降到(1.0±1.1) mm,CMA由124.2°±8.1°提高至143.8°±5.1°,差异均有统计学意义(P <0.01)。随访6~28个月,平均13.5月,末次随访m JOA评分由术前(10.9±1.7)分提升到(13.2±4.1)分,差异有统计学意义(P <0.01)。随访6个月时,16例寰枢椎侧块关节面达到不同程度骨融合。结论应用寰枢关节间直接撑开技术治疗CAAD安全、有效、简便、灵活。
Objective To investigate the efficacy and safety of atlantoaxial joint direct distraction technique for the treatment of congenital atlantoaxial dislocation(CAAD). Methods Clinical and imaging data of 17 CAAD patients undergoing atlantoaxial joint direct distraction technique were analyzed retrospectively. Imaging evaluation was performed by atlas-dens interval( ADI) and cervicomedullary angle(CMA) in all the patients, and the neurological function was evaluated with modified Japanese orthopaedic association(m JOA) scores before and after the operation. All of the above data were statistically analyzed. Results The postoperative clinical symptoms were obviously improved in 16 patients and unchanged in 1. No death or infection case occurred. The ADI value decreased from preoperative 5.1±1.4 mm to postoperative 1.0±1.1 mm, while the CMA value increased from 124.2°±8.1° to 143.8°±5.1°, and there all were significant differences(P < 0.01). The mean follow-up period was 13.5 months, range from 6 to 28 months.The m JOA scores increased from preoperative 10.9±1.7 scores to postoperative 13.2±4.1 scores at the last follow-up, and significant difference was found between them(P < 0.01). The bone fusion to different degrees was formed between the atlantoaxial articular surfaces in 16 patients at 6 months after the operation. Conclusion Atlantoaxial joint direct distraction technique is a safe, effective,simple and flexible method for the treatment of CAAD.
作者
尚国松
范涛
侯哲
梁聪
王寅千
赵新岗
Shang Guosong;Fan Tao;Hou Zhe;Liang Cong;Wang Yinqian;Zhao Xin’gang(Department of Neurosurgery, Linfen People's Hospital, Linfen, Shanxi 041000, China;Department of Spine Center, Sanbo BrainHospital, Capital Medical University, Beijing 100093, China;Department of Neurosurgery, Beijing Luhe Hospital, Capital MedicalUniversity, Beijing 101149, China)
出处
《中国微侵袭神经外科杂志》
CAS
2019年第6期245-248,共4页
Chinese Journal of Minimally Invasive Neurosurgery
基金
国家临床重点专科基金[编号:873(2011)]
首都卫生科研发展专项基金[编号:2-8011(2014)]
关键词
脱位
寰枢关节
先天性
撑开技术
关节间
减压术
颅后窝
dislocation,atlanto-axial joint,congenital
interarticular distraction technique
decompression,posterior cranial fossa
