Chi Yong-long, Xu Hua-zi, Lin Yan, Huang Qi-shan, Mao Fang-min, Wang Xiang-yang, Ni Wen-fei
Department of Orthopaedic, the Second Affiliated Hospital, Wenzhou Medical College, Wenzhou 325027, China.
Zhonghua Wai Ke Za Zhi. 2007 Mar 15;45(6):383-6.
To evaluate the safety and efficacy of one-stage percutaneous microendoscopic anterior release, trans-articular fixation and fusion to reduce and stabilize for irreducible atlanto-axial dislocation.
Eight consecutive patients were treated by percutaneous microendoscopic anterior release, trans-articular C(1-2) fixation and bone graft fusion. The mean age was 33 years (range, 28-52 years). The pathology included odontoid dysplasia in 3 patients, chronic odontoid fractures in 2, odontoid absence in 1, fasilar impression in 1 and malunion of odontoid fracture in 1. The classification of disability was that proposed by Symon and Lavender. There were moderate disability in 4, severe non-bedbound in 3, and severe bedridden in 1.
The new technique was performed successfully in all cases. All patients underwent trans-articular C(1-2) screw fixation and anterior bone graft fusion. The average operation time was 120 min (90-150 min), and the average estimated blood loss was 150 ml (100-250 ml). Seven cases resulted in anatomic reduction, 1 had partial reduction. The follow-up period was 8-16 months. The effective rate was 100%, and the excellent rate was 51.25%; the average improvement rate for the spinal canal decompression was 76.5%. There was no instrument failure or pseudarthrosis, and solid fusion was achieved in the all cases. The loss of axial rotation of cervical spine was 30-40 degrees .
Percutaneous microendoscopic anterior release, fixation and fusion is an effective, reliable, and safe procedure for the treatment of irreducible atlanto-axial dislocation.
评估一期经皮微创前路松解、关节突固定融合术治疗难复性寰枢椎脱位并进行复位与稳定的安全性及有效性。
连续8例患者接受经皮微创前路松解、C（1-2）关节突固定及植骨融合术治疗。平均年龄33岁（范围28-52岁）。病理类型包括齿状突发育不良3例、陈旧性齿状突骨折2例、齿状突缺如1例、斜坡压迫症1例、齿状突骨折畸形愈合1例。残疾分类采用Symon和Lavender提出的标准。中度残疾4例，重度非卧床3例，重度卧床1例。
所有病例新技术均成功实施。所有患者均接受C（1-2）关节突螺钉固定及前路植骨融合术。平均手术时间120分钟（90-150分钟），平均估计失血量150毫升（100-250毫升）。7例解剖复位，1例部分复位。随访时间8-16个月。有效率100%，优良率51.25%；椎管减压平均改善率76.5%。无内固定失败或假关节形成，所有病例均获得牢固融合。颈椎轴向旋转丧失30-40度。
经皮微创前路松解、固定融合术是治疗难复性寰枢椎脱位的一种有效、可靠且安全的手术方法。
