Wu Yao-Sen, Chi Yong-Long, Wang Xiang-Yang, Xu Hua-Zi, Lin Yan, Mao Fang-Min, Huang Qi-Shan, Ni Wen-Fei
Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, China.
J Spinal Disord Tech. 2010 Apr;23(2):113-20. doi: 10.1097/BSD.0b013e3181988bf5.
Surgical techniques and preliminary results.
To describe and evaluate the safety and efficacy of a new minimal invasive technique for the irreducible atlantoaxial dislocation (IADD).
Endoscope has been widely used in minimal invasive spinal surgery. However, there are no clinical reports regarding anterior approach for IADD in the literature.
Ten consecutive patients with IADD were treated by anterior release with microendoscopic aide and subsequently reduction, anterior transarticular screw fixation and morselized autologous bone grafts. There were 3 cases of odontoid dysplasia, 4, chronic odontoid fracture, 1, odontoid absence, 1 fasilar impression, and 1 malunion of odontoid fracture. According to Symon and Lavender's classification of disability, 6 cases were moderate disability, 3 severe nonbedbound, and 1 severe bedridden. The procedure was performed by the same surgeon (Yong-Long Chi).
The new technique was performed successfully in all cases. All the patients underwent transarticular screw fixation and anterior morselized autograft fusion. The average operation time was 120 min (range, 90 to 150 min) and the mean estimated blood loss was 150 mL (range, 100 to 250 mL). Postoperative radiographs demonstrated that 9 cases restored anatomic position and 1 had partial reduction. According to the postoperative computed tomography all the screws were appropriately placed. Follow-up after surgery, longest is 16 months and minimal 8 months with a mean of 12 months, neurologic status was improved in all patients. There was no loss of fixation and solid fusion was achieved in all cases.
Surgical technique of microendoscopic anterior release, reduction, fixation, and fusion is safe and reliable minimally invasive for treating IADD.
手术技术与初步结果。
描述并评估一种治疗难复性寰枢椎脱位（IADD）的新型微创技术的安全性和有效性。
内窥镜已广泛应用于微创脊柱手术。然而，文献中尚无关于IADD前路手术的临床报道。
连续10例IADD患者接受了在微型内窥镜辅助下的前路松解，随后进行复位、经关节螺钉固定和自体碎骨移植。其中齿状突发育不良3例，陈旧性齿状突骨折4例，齿状突缺如1例，斜坡压迫1例，齿状突骨折畸形愈合1例。根据Symon和Lavender的残疾分类，中度残疾6例，重度非卧床3例，重度卧床1例。手术由同一位外科医生（池永龙）完成。
所有病例均成功实施了新技术。所有患者均接受了经关节螺钉固定和前路碎骨自体骨融合。平均手术时间为120分钟（范围90至150分钟），平均估计失血量为150毫升（范围100至250毫升）。术后X线片显示9例恢复了解剖位置，1例部分复位。根据术后计算机断层扫描，所有螺钉位置合适。术后随访时间最长16个月，最短8个月，平均12个月，所有患者神经功能均有改善。无内固定松动，所有病例均实现了牢固融合。
微型内窥镜前路松解、复位、固定和融合手术技术治疗IADD安全可靠，创伤小。
