寰枢椎脱位手术后翻修的原因及策略

发布时间：2018-06-05 00:12

本文选题：寰枢椎脱位 + 翻修手术　；参考：《中国脊柱脊髓杂志》2017年03期

【摘要】：目的 :分析寰枢椎脱位手术后翻修的原因,探讨其策略。方法 :回顾性分析15例寰枢椎脱位手术后翻修患者,男11例,女4例,翻修时年龄15~68岁(46.60±14.95岁);两次手术相隔2~120个月(28.73±38.59个月)。根据影像资料及手术探查情况分析翻修原因。翻修手术中均行8~10kg颅骨牵引及后方松解;后方结构完整患者行后路固定,根据松解后复位情况决定是否选择前路松解术;1例后路减压患者行前路松解复位固定术。导航模板辅助置入寰枢椎螺钉;自体髂骨松质骨颗粒植骨。随访观察寰枢椎复位、螺钉位置、植骨融合及手术疗效。结果:翻修原因,减压或复位不足10例,内固定失败3例,植骨未融合3例(含植骨未融合致内固定失败1例)。15例翻修手术中,14例为后路固定手术,1例为前路固定手术。通过术中颅骨牵引及充分松解,13例获得解剖复位;2例因广泛骨性融合,无法牵引复位,切除齿状突后彻底减压。导航模板辅助下共置入寰枢椎螺钉42枚,均一次性置入;置钉准确率97.6%。随访3~36个月(16.0±4.2个月),所有病例骨性融合,融合时间为3~6个月(3.7±0.5个月);末次随访JOA评分为13.8±3.1分(11~16分),较术前评分8.1±2.3分(6~11分)明显提高,改善率为(64.0±21.2)%(45.4%~88.8%)。结论:寰枢椎脱位手术后翻修的原因为减压或复位不足、内固定失败以及植骨未融合。充分的术中松解、8~10kg的颅骨牵引、恰当的骨质切除减压有利于翻修术中寰枢椎的复位,导航模板辅助有利于提高置钉准确性。
[Abstract]:Objective: to analyze the reasons for the refurbishment of atlantoaxial dislocation after surgery. Methods: a retrospective analysis of 15 cases of atlantoaxial dislocation after refurbishment, male 11, female 4, aged 15~68 years (46.60 + 14.95 years) and two months (28.73 + 38.59 months) during the refurbishment, and the analysis of the refurbishment according to the imaging data and surgical exploration. 8~10kg cranial traction and posterior loosening were performed during the refurbishment operation; the posterior structure intact patients were fixed after the posterior approach to decide whether to choose anterior release; 1 patients with posterior decompression were treated with anterior release and reduction and fixation. The navigation template assisted the atlantoaxial screw; autogenous iliac cancellous bone grafts. Atlantoaxial reduction, screw position, bone graft fusion and surgical effect. Results: repair causes, decompression or reduction of 10 cases, 3 cases of internal fixation failure, 3 cases of bone graft failure (including 1 cases of internal fixation failure due to bone graft failure), 14 cases for posterior fixation and 1 cases of anterior fixation, with cranial traction and adequate release during operation. 13 cases received anatomic reduction, 2 cases had no traction reduction and complete decompression after removal of odontoid process because of extensive bone fusion. A total of 42 atlantoaxial screws were inserted with the aid of navigation template. The accuracy rate of 97.6%. was followed up for 3~36 months (16 + 4.2 months), all cases of bone fusion, the time of fusion was 3~6 months (3.7 + 0.5 months); the last time was the last time. The follow-up JOA score was 13.8 + 3.1 (11~16), compared with the preoperative score of 8.1 + 2.3 (6~11), and the improvement rate was (64 + 21.2)% (45.4%~88.8%). Conclusion: the reasons for the refurbishment after atlantoaxial dislocation were decompression or reduction, internal fixation failure and unfusion of bone graft. Adequate intraoperative loosening, 8~10kg cranial traction, appropriate bone cutting. Besides decompression, it is beneficial to the reduction of atlantoaxial vertebrae during revision. Navigation template assistance is helpful to improve the accuracy of placement.
【作者单位】：西安交通大学第二附属医院骨科;青岛市市立医院脊柱外科;
【基金】：国家自然科学基金资助项目(编号:81571209) 陕西省自然科学基金资助项目(编号:2016JM8054)
【分类号】：R687.3

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