摘要
目的探讨斜切面非金属微创通道下经常规Smith-Robinson前外侧入路进行寰枢关节松解联合后路固定治疗难复性寰枢关节脱位的可行性及安全性。方法回顾性分析2013年5月至2021年12月收治的5例难复性寰枢关节脱位患者的病历资料,男3例,女2例;年龄(44.6±9.0)岁(范围38~61岁)。采用斜切面非金属微创通道下经常规Smith-Robinson前外侧入路进行寰枢关节松解联合后路固定手术治疗。主要观察指标包括日本矫形外科协会(Japanese Orthopedic Association,JOA)评分及JOA评分改善率、美国脊髓损伤协会(American Spinal Injury Association,ASIA)分级、寰齿前间距(atlantodental interval,ADI)及复位指数、寰椎平面脊髓有效空间(space available for the cord,SAC)及植骨融合情况。结果随访时间(80.0±23.1)月(范围34~96个月),前路松解时间(105±23)min(范围75~135 min),总手术时间(234±42)min(范围212~276 min),前路手术出血量为(80±16)ml(范围60~100 ml),总术中出血量(123±34)ml(范围86~150 ml)。术前JOA评分为(6.6±0.9)分,术后1个月为(11.2±0.4)分,末次随访时为(14.8±0.80)分,差异有统计学意义(F=97.28,P<0.001),末次随访时JOA评分改善率为79.1%±7.64%。术前ASIA分级为C级3例,D级2例;至末次随访时ASIA分级为D级2例,E级3例。术前ADI为(9.56±1.07)mm,术后6个月为(1.46±0.39)mm,末次随访时(1.48±0.29)mm,差异有统计学意义(F=206.54,P<0.001)。末次随访时复位指数为84.6%±1.4%。术前SAC为(10.3±1.83)mm,术后6个月为(20.12±1.19)mm,末次随访时为(20.06±1.25)mm,差异均有统计学意义(F=44.47,P<0.001)。术后6个月有3例患者植骨已融合,术后12个月5例患者均获良好的植骨融合。1例患者术后14个月时因外伤导致钛棒断裂,其余患者无并发症发生。结论对于难复性寰枢关节脱位应用斜切面非金属微创通道下经常规Smith-Robinson前外侧入路进行寰枢关节松解联合后路固定手术,可取得良好的复位及神经功能改善,手术安全、有效,术后疗效满意。
Objective To investigate the feasibility and safety of a novel surgery,to restore irreducible atlantoaxial dislocation(IAAD)by atlantoaxial joint release through wedge-end-mini-channel(via conventional Smith-Robinson anterolateral approach)combined with posterior fixation.Methods Five patients with IAAD from May 2013 to December 2021 were retrospectively analyzed,including 3 males and 2 females,aged 44.6±9.0 years(range,38-61).All the patients received atlantoaxial joint release through wedge-end-mini-channel(via conventional Smith-Robinson anterolateral approach)combined with posterior fixation.The Japanese Orthopedic Association(JOA)score and improvement rate,American Spinal Injury Association(ASIA)grade,atlantodental interval(ADI)and reduction rate,space available for the cord(SAC)and fusion of bone graft were measured and recorded.Results The follow-up time was 80.0±23.1 months(range,34-96 months).The surgery time of anterior joint release was 105±23 min(range,75-135 min),and the total surgery time was 234±42 min(range,212-276 min).The blood loss of anterior joint release was 80±16 ml(range,60-100 ml),and the total blood loss was 123±34 ml(range,85-150 ml).JOA scores were 6.6±0.9 before surgery,11.2±0.4 at post-operative 1 month,and 14.8±0.80 at the last follow-up(F=97.28,P<0.001),and the improvement rate of the last follow-up JOA score was 79.1%±7.64%.The ASIA grade were three cases of'C’level and two cases of'D’level before surgery,and two cases of'D’level and three cases of'E’level at the last follow-up.The ADI before surgery,at post-operative 6 months and the last follow-up were 9.56±1.07 mm,1.46±0.39 mm and 1.48±0.29 mm,respectively(F=206.54,P<0.001).The reduction rate of last follow-up ADI was 84.6%±1.4%.The SAC before surgery,at post-operative 6 months and last follow-up were 10.3±1.83 mm,20.12±1.19 mm and 20.06±1.25 mm,respectively(F=44.47,P<0.001).Grafted bone fuse was seen in 3 cases at post-operative 6 months,and 5 cases at post-operative 12 months.The only complication was unexpected titanium rod fracture in 1 case at post-operative 14 months.Conclusion For IAAD,the novel surgery of atlantoaxial joint release through wedge-end-mini-channel(via conventional Smith-Robinson anterolateral approach)combined with posterior fixation could achieve well joint restoration and neural function improvement,which was a safe and effective procedure.
作者
李乐
李牧
司海朋
Li Le;Li Mu;Si Haipeng(Department of Orthopaedics,Qilu Hospital of Shandong University,Jinan 250012,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2022年第7期463-470,共8页
Chinese Journal of Orthopaedics
关键词
寰枢关节
脱位
外科手术
微创性
脊柱融合术
Atlanto-axial joint
Dislocations
Surgical procedures,Minimally invasive
Spinal fusion
