显微镜辅助下前路经口松解治疗难复性寰枢椎脱位

发布时间：2018-10-16 12:44

【摘要】：[目的]探讨显微镜辅助下前路经口松解治疗难复性寰枢椎脱位的适应证及临床疗效。[方法]回顾分析2013年11月~2016年12月解放军总医院及清华大学附属北京清华长庚医院骨科收治的15例应用显微镜辅助下行前路经口松解的难复性寰枢椎脱位的病例。记录手术时间、出血量、神经功能及并发症情况。比较手术前后JOA评分及寰齿间隙测量值。[结果]15例患者平均前路手术时间78 min(67~112 min),平均出血量24 ml(10~65 ml)。显微镜使用时间平均39 min(24~57min)。术中未出现脑脊液漏及脊髓损伤,术后检查未见血肿形成。术后第1 d症状及神经功能即得到不同程度改善,无神经功能加重病例。术前寰齿间隙平均(10.37±1.77)mm,JOA评分平均(9.07±1.62)分。术后寰齿间隙平均(3.87±0.75)mm,JOA评分平均(12.20±1.57)分。平均随访17个月(4~32个月),至末次随访,患者均恢复工作和日常活动,复查寰齿间隙(3.98±0.75)mm,JOA评分平均达(15.80±1.21)分。未发生再次脱位及脊髓损伤加重者。[结论]治疗难复性上颈椎畸形,采用显微镜辅助下前路经口松解,较传统直视下手术视野清晰,操作精准,损伤小,止血彻底;能够达到优良手术效果。
[Abstract]:Objective: to investigate the indications and clinical effects of microscopically assisted anterior approach for the treatment of irreducible atlantoaxial dislocation. [methods] from November 2013 to December 2016, 15 cases of refractory atlantoaxial dislocation treated in General Hospital of PLA and Department of Orthopaedics of Tsinghua Changg Hospital affiliated to Tsinghua University were analyzed retrospectively. The time of operation, blood loss, neurological function and complications were recorded. JOA scores and atlantodentate space measurements were compared before and after operation. [results] the average operation time of anterior approach was 78 min (67 ~ 112 min),) in 15 patients. The average bleeding volume was 24 ml (1 065 ml). The mean operating time of microscope was 39 min (24~57min). No cerebrospinal fluid leakage and spinal cord injury occurred during the operation, and no hematoma formation was observed after operation. On the first day after operation, the symptoms and neurological function were improved to some extent, and no exacerbation of neurological function was found. The mean atlantodentate space score was (10.37 卤1.77) mm,JOA score (9.07 卤1.62). The average atlantodentate space score was (3.87 卤0.75) mm,JOA score (12.20 卤1.57). The patients were followed up for an average of 17 months (4 ~ 32 months). To the last follow-up, all the patients resumed their work and daily activities, and the average mm,JOA score of atlantodentate space was (15.80 卤1.21). No redislocation or exacerbation of spinal cord injury occurred. [conclusion] in the treatment of intractable upper cervical deformity, the anterior approach of microscopically assisted anterior decompression is better than that of conventional direct vision surgery with clear visual field, precise operation, less injury and complete hemostasis, which can achieve good surgical effect.
【作者单位】：清华大学附属北京清华长庚医院骨科;
【分类号】：R687.3

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