应用改良Harms钉棒技术治疗寰椎枕骨化的寰枢椎脱位

发布时间：2018-10-31 09:33

【摘要】：[目的]探讨采用改良Harms钉棒技术治疗寰椎枕骨化的寰枢椎脱位患者的可行性和价值。[方法]2012年1月~2014年1月,采用改良Harms钉棒技术治疗寰椎枕骨化的寰枢椎脱位患者11例,男7例,女4例;年龄14~60岁,平均为33.4岁。11例患者均存在不同程度的慢性进展性四肢无力和感觉异常。术前均行X线片、CT及MRI检查,术前JOA评分11~14分,平均13.3分。记录手术时间、手术失血量、术中及术后并发症。术后常规行X线片、CT检查以评估复位情况及内固定位置。出院后常规门诊随访。[结果]11例均成功进行了对枕骨化的寰椎及枢椎的钉棒固定融合术。手术时间90~160 min,平均119 min,术中出血量150~300 ml,平均245 ml。术中无椎动脉、静脉丛、神经根、脊髓及硬膜损伤。术后无感染、C2神经功能障碍及枕部皮肤压疮。全部患者均获得随访,随访时间9~28个月,平均19个月。患者均获得骨性融合,无内固定松动、移位及断裂。11例症状均获得不同程度缓解,末次随访JOA评分14~17分,平均15.8分。[结论]应用改良Harms钉棒技术对寰椎枕骨化的寰枢椎脱位患者行寰枢椎钉棒复位、固定及融合是治疗该类患者的一种简单、有效的方法,避免了使用枕颈内固定器械所带来的并发症;与Goel技术相比,操作更简便,并且能够避免术后C2神经功能障碍。
[Abstract]:Objective] to evaluate the feasibility and value of modified Harms technique in the treatment of atlantoaxial dislocation. [methods] from January 2012 to January 2014, 11 patients (7 males and 4 females) with atlantoaxial dislocation were treated with modified Harms screw technique. The average age was 33.4 years old (140-60 years). All the 11 patients had chronic progressive limb weakness and abnormal sensation. X-ray, CT and MRI were performed before operation. The preoperative JOA score was 11 ~ 14 (mean 13.3). The operative time, blood loss, intraoperative and postoperative complications were recorded. X-ray films and CT were performed to evaluate the reduction and the position of internal fixation. Routine outpatient follow-up after discharge. [results] 11 cases of occipital atlas and axis were treated successfully. Operative time: 90 min, 160 min, mean intraoperative blood loss, 150 ml, 300 ml, average 245 ml. No vertebral artery, venous plexus, nerve root, spinal cord or dural injury were found during the operation. There was no infection, C 2 nerve dysfunction and occipital skin pressure sore. All patients were followed up for 9 ~ 28 months (mean 19 months). Bone fusion was achieved without internal fixation loosening displacement and rupture. The symptoms of 11 patients were relieved to varying degrees. The JOA score of the last follow-up was 14 ~ 17 with an average of 15. 8. [conclusion] modified Harms screw rod technique is a simple and effective method for the treatment of atlantoaxial dislocation. The complications caused by the use of occipitocervical internal fixation instruments are avoided. Compared with Goel technique, it is easier to operate and can avoid C 2 neurological dysfunction after operation.
【作者单位】：西安交通大学医学部附属红会医院脊柱外科;
【分类号】：R687.3

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