双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合治疗可复性寰枢椎脱位的中长期随访报告

发布时间：2018-12-16 12:41

【摘要】：目的:评估双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合治疗可复性寰枢椎脱位的中长期疗效。方法:回顾性分析85例在我院接受双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合术的可复性寰枢椎脱位患者的临床资料,其中男21例,女64例;年龄25~65岁(44±9.4岁)。寰椎爆裂性骨折19例,C1、2旋转脱位畸形16例,齿状突骨折26例,齿状突游离15例,寰椎类风湿性关节炎致寰枢椎脱位9例。通过Ranawat分级、颈椎功能障碍指数(NDI)以及颈部/枕骨下疼痛视觉模拟量表(visual analogue scale,VAS)评分评估患者的临床疗效;在术前和末次随访时的颈椎正侧位X线片、MRI、CT三维重建等资料中,提取以下影像学数据:寰齿前间距(atlanto-dental interval,ADI)、有效椎管容积(space available for cord,SAC)、C1-2角、C2-7角,并观察植骨融合情况及颈椎稳定性。结果:所有患者均完成5年以上的随访。末次随访时24例术前存在脊髓压迫症状患者的Ranawat分级有所改善;95%的患者颈部疼痛得到缓解,VAS评分由术前7.56±1.03分下降至2.53±0.53分(P0.05);NDI由术前34.76±5.45分降至13.13±1.21分(P0.05)。ADI由术前6.5±1.0mm降至2.4±0.9mm(P0.05);SAC由术前13.37±2.11mm增大至19.93±2.20mm(P0.05)。手术前C1-2角为21.9°±1.2°,末次随访时为26.6°±6.9°;手术前C2-7角为19.8°±9.2°,末次随访时为15.5°±5.9°。术后6个月,81例(95.3%)患者获得良好的植骨融合,4例患者出现植骨延迟愈合。结论:双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合治疗可复性寰枢椎脱位的长期疗效优良,是一种安全、可靠的后路寰枢椎固定融合技术。
[Abstract]:Objective: to evaluate the long-term treatment of atlantoaxial dislocation with bilateral transatlantoaxial screw fixation. Methods: the clinical data of 85 patients with atlantoaxial dislocation underwent bilateral transatlantoaxial screw fixation with laminar hook fixation were retrospectively analyzed, including 21 males and 64 females, aged 2565 years (44 卤9.4 years). There were 19 cases of burst fracture of atlas, 16 cases of C1M 2 rotation dislocation, 26 cases of odontoid fracture, 15 cases of free odontoid process, 9 cases of atlantoaxial dislocation caused by atlantoid rheumatoid arthritis. The clinical efficacy was evaluated by Ranawat grade, cervical spine dysfunction index (NDI) and cervical / occipital pain visual analogue scale (visual analogue scale,VAS). The following imaging data were extracted from the X-ray films of anterior and lateral cervical vertebrae before operation and at the last follow-up, MRI,CT 3D reconstruction and so on: anterior atlantodentate spacing (atlanto-dental interval,ADI), effective spinal canal volume (space available for cord,SAC), C1-2 angle, and so on. C 2-7 angle, bone graft fusion and cervical stability were observed. Results: all patients were followed up for more than 5 years. At the last follow-up, the Ranawat grade of 24 patients with spinal cord compression symptoms was improved, 95% of the patients were relieved of neck pain, the VAS score decreased from 7.56 卤1.03 to 2.53 卤0.53 (P0.05). NDI decreased from 34.76 卤5.45 to 13.13 卤1.21 (P0.05). ADI from 6.5 卤1.0mm to 2.4 卤0.9mm) (P0.05); SAC increased from 13.37 卤2.11mm to 19.93 卤2.20mm (P0.05). The angle of C1-2 was 21.9 掳卤1.2 掳before operation, 26.6 掳卤6.9 掳at last follow-up, 19.8 掳卤9.2 掳before operation and 15.5 掳卤5.9 掳at last follow-up. After 6 months, 81 patients (95.3%) had good bone graft fusion and 4 patients had delayed union. Conclusion: bilateral transatlantoaxial screw fixation and bone grafting for atlantoaxial dislocation is a safe and reliable posterior approach for the treatment of atlantoaxial dislocation.
【作者单位】：第二军医大学附属长征医院脊柱四科;
【分类号】：R687.3

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