手术治疗寰枢椎不稳定
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摘要
目的
回顾性分析寰枢椎不稳临床病例的治疗方法及效果,探讨不同类型寰枢椎不稳手术方式的选择和治疗策略。
资料与7方法
2007年12月至2010年8月郑州大学第一附属医院骨二科收治的61例不同原因引起的寰枢椎不稳病例,男32例,女29例,年龄12～68岁,平均38岁。临床诊断为齿状突骨折10例,齿状突发育畸形、游离齿状突6例,寰枢椎半脱位20例,寰枢椎脱位27例。病因包括：创伤12例,炎症性关节炎3例,先天性发育畸形38例,病因不明8例。根据各自病例的具体情况分别采用Halo-vest外固定术5例、前路空心螺钉齿状突内固定术5例、寰枢植骨融合内固定术23例、枕颈植骨融合内固定术28例。术前、术后分别采用JOA评分法评定神经功能,影像学检查评定植骨融合情况。
结果
61例病人随访10天——36月,平均19.6月,其中1例术后10天发生中枢性呼吸困难、中枢性高热、多器官衰竭而死亡。其余60例患者随访3月——36月,均获得骨性愈合,其中延迟愈合2例。60例患者术后症状消失或基本消失37例,明显改善11例,轻度改善2例,JOA评分改善分平均为5.54,总体改善率0.76。51例后路内固定病例头颈部旋转活动受限明显。术中未发生椎动脉损伤、脊髓神经损伤等。1例术中并发脑脊液漏、1例术后并发切口脂肪液化渗出。所有内固定均未出现内固定物松动、脱落、断裂等现象。
结论
手术方案的选择主要取决于寰枢椎不稳的原因、类型、牵引后复位的难易程度,以及在重建稳定性满意的前提下,尽可能地保留上颈椎的功能。据此选择恰当合理的手术方案和治疗策略,可获得满意的治疗效果。
Objective
To retrospectively analyse the surgical method and its clinical effectiveness for atlantoaxial instability and evaluate surgical options for different types.
Methods
Sixty one patients with atlantoaxial instability were surgical treated at the authors'clinic from December 2007 to August 2010. There were 32 males and 29 females and the average age was 38 years old (range,12-68years old). There were 10 patients with unstable odontiod fracture,6 cases with odontoid deformity and os odontiodeum,27 cases with atlantoaxial dislocation,20 cases with sub luxation. The causes include:trauma in 12 cases, inflammatory arthropathy in 3 cases, congenital developmental malformation in 38 cases, and etiology unknown in 8 cases. Patients were treated by different surgical approaches,5 cases by external fixation with Halo-vest,5 cases by anterior fixation of the dens fractue with a cannulate screw,23 cases by posterior C1-C2 fusion,28 cases by occipitocervical fusion. The preoperative and postoperative Japanese Orthopaedic Association (JOA) scores were adopted to evaluate neural functions and medical imaging examination was taken to evaluate bone fusion.
Results
All the Sixty one patients were followed up for an average of 19.6 months range,10 days to 36mnths). One patient died of multiple organ dysfunction syndrome 10 days after surgery, the other 60 patients were followed up from 3 to 36 months. Solid union was obtained in 60 cases with delayed union among them. The symptoms subsided in 37cases, significantly improved in 11 cases, slightly improved in 2 cases. JOA score improved with the average of 5.54, the total improvement rate was 0.76. Obvious limitation of rotative activity were founed in all 51 patients with posterior internal fixation. No such complications as injury to vertebral artery and spinal cord were met in all patients. There were one case had cerebrospinal leak and one with incision fat liquefy. No migration, loosening and breakage of internal fixators were founded in all patients.
Conclusion
Selection of surgical method mainly depends on causes and types of atlantoaxial instability and the result of traction reduction to achive atlantoaxial stability and preserve the upper cervical spine function as more as possible. According to this principle, appropriate surgery and treatment strategies could be selected, and satisfactory treatment effectiveness could be obtained.
回顾性分析寰枢椎不稳临床病例的治疗方法及效果,探讨不同类型寰枢椎不稳手术方式的选择和治疗策略。
资料与7方法
2007年12月至2010年8月郑州大学第一附属医院骨二科收治的61例不同原因引起的寰枢椎不稳病例,男32例,女29例,年龄12～68岁,平均38岁。临床诊断为齿状突骨折10例,齿状突发育畸形、游离齿状突6例,寰枢椎半脱位20例,寰枢椎脱位27例。病因包括：创伤12例,炎症性关节炎3例,先天性发育畸形38例,病因不明8例。根据各自病例的具体情况分别采用Halo-vest外固定术5例、前路空心螺钉齿状突内固定术5例、寰枢植骨融合内固定术23例、枕颈植骨融合内固定术28例。术前、术后分别采用JOA评分法评定神经功能,影像学检查评定植骨融合情况。
结果
61例病人随访10天——36月,平均19.6月,其中1例术后10天发生中枢性呼吸困难、中枢性高热、多器官衰竭而死亡。其余60例患者随访3月——36月,均获得骨性愈合,其中延迟愈合2例。60例患者术后症状消失或基本消失37例,明显改善11例,轻度改善2例,JOA评分改善分平均为5.54,总体改善率0.76。51例后路内固定病例头颈部旋转活动受限明显。术中未发生椎动脉损伤、脊髓神经损伤等。1例术中并发脑脊液漏、1例术后并发切口脂肪液化渗出。所有内固定均未出现内固定物松动、脱落、断裂等现象。
结论
手术方案的选择主要取决于寰枢椎不稳的原因、类型、牵引后复位的难易程度,以及在重建稳定性满意的前提下,尽可能地保留上颈椎的功能。据此选择恰当合理的手术方案和治疗策略,可获得满意的治疗效果。
Objective
To retrospectively analyse the surgical method and its clinical effectiveness for atlantoaxial instability and evaluate surgical options for different types.
Methods
Sixty one patients with atlantoaxial instability were surgical treated at the authors'clinic from December 2007 to August 2010. There were 32 males and 29 females and the average age was 38 years old (range,12-68years old). There were 10 patients with unstable odontiod fracture,6 cases with odontoid deformity and os odontiodeum,27 cases with atlantoaxial dislocation,20 cases with sub luxation. The causes include:trauma in 12 cases, inflammatory arthropathy in 3 cases, congenital developmental malformation in 38 cases, and etiology unknown in 8 cases. Patients were treated by different surgical approaches,5 cases by external fixation with Halo-vest,5 cases by anterior fixation of the dens fractue with a cannulate screw,23 cases by posterior C1-C2 fusion,28 cases by occipitocervical fusion. The preoperative and postoperative Japanese Orthopaedic Association (JOA) scores were adopted to evaluate neural functions and medical imaging examination was taken to evaluate bone fusion.
Results
All the Sixty one patients were followed up for an average of 19.6 months range,10 days to 36mnths). One patient died of multiple organ dysfunction syndrome 10 days after surgery, the other 60 patients were followed up from 3 to 36 months. Solid union was obtained in 60 cases with delayed union among them. The symptoms subsided in 37cases, significantly improved in 11 cases, slightly improved in 2 cases. JOA score improved with the average of 5.54, the total improvement rate was 0.76. Obvious limitation of rotative activity were founed in all 51 patients with posterior internal fixation. No such complications as injury to vertebral artery and spinal cord were met in all patients. There were one case had cerebrospinal leak and one with incision fat liquefy. No migration, loosening and breakage of internal fixators were founded in all patients.
Conclusion
Selection of surgical method mainly depends on causes and types of atlantoaxial instability and the result of traction reduction to achive atlantoaxial stability and preserve the upper cervical spine function as more as possible. According to this principle, appropriate surgery and treatment strategies could be selected, and satisfactory treatment effectiveness could be obtained.
引文
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