摘要
寰枢椎后路侧块关节融合术是治疗寰枢椎脱位、颅底凹陷症、颅颈交界区畸形等疾病的重要外科技术,可有效改善神经症状,增加上颈椎生物力学稳定性及提高骨融合率。寰枢椎后路侧块关节融合术治疗颅颈交界区疾病的手术操作规范尚无指导性文件。为明确其手术适应证,规范寰枢椎后路侧块关节融合术的技术操作及并发症的处理,中国康复医学会脊柱专业委员会颈椎研究学组组织相关领域专家,基于循证医学证据并参考国内外最新研究进展,制订《寰枢椎后路侧块关节融合术操作规范专家建议(2026年版)》。专家建议主要针对寰枢椎前脱位,系统阐述了寰枢椎后路侧块关节融合术中关节间隙及C_(2)神经根的处理、植骨材料的选择、内固定的置入策略、寰枢椎的复位方式及椎动脉损伤、脊髓损伤、脑脊液漏、结构性植骨材料相关并发症、融合失败的处理方法,旨在规范寰枢椎后路侧块关节融合技术的临床应用,改善临床预后。
Posterior atlantoaxial lateral mass arthrodesis(PALMA)is a critical surgical technique for treating atlantoaxial dislocation,basilar invagination and craniovertebral junction(CVJ)anomalies.It effectively alleviates neurological symptoms,enhances biomechanical stability of the upper cervical spine,and improves the bony fusion rate.Currently,there is a lack of standardized guidelines on the surgical protocol for PALMA in managing CVJ diseases.To clarify its surgical indications,standardize the technical procedures and complication managements,the Cervical Spine Research Group of the Spine Committee under the Chinese Association of Rehabilitation Medicine organized a panel of experts.Based on evidence-based medicine and incorporating the latest domestic and international research advancements,the group has established the"Expert Recommendations on Technical Guidelines for Posterior Atlantoaxial Lateral Mass Arthrodesis(2026 edition)".Illustrated by the case of atlantoaxial anterior dislocation,the expert recommendations standardize key procedures of PALMA,including the management of the interarticular space and the C_(2) nerve root,selection of bone grafting materials,strategies for internal fixation placement,and techniques for atlantoaxial reduction,guidance on complication managements such as vertebral artery injury,spinal cord injury,cerebrospinal fluid leakage,issues related to structural bone grafts,and fusion failure.The development of the recommendation aims to standardize the clinical application of PALMA technology and ultimately improve clinical outcomes.
作者
中国康复医学会脊柱专业委员会颈椎研究学组
艾福志
莫少东
Cervical Spine Research Group of the Spine Committee,Chinese Association of Rehabilitation Medicine;Ai Fuzhi
出处
《中华骨科杂志》
北大核心
2026年第3期162-168,共7页
Chinese Journal of Orthopaedics
关键词
寰枢关节
脊柱融合
规范
Atlanto-axial joint
Spinal fusion
Benchmarking
