Zhang Hui, Jin Anmin, Zhang Li, Zhou Zhilai, Duan Yang, Min Shaoxiong
Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2012 Sep;32(9):1358-61.
To summarize the techniques and evaluate the therapeutic effect of posterior fixation and fusion in the treatment of Os odontoideum complicated by atlantoaxial dislocation.
From March, 2007 to October, 2010, 10 patients with Os odontoideum (including 6 male and 4 female patients aged from 20 to 65 years, mean 39.8 years) were treated in our hospital. Before and after the operation, the patients underwent X ray, CT and MRI examinations to measure and evaluate the degree of dislocation and neural compression. After preoperative traction for 1-2 weeks, all the 10 patients showed deductible atlantoaxial dislocation. Through a posterior approach, Atlantoaxial pedicle screws fixation were performed in 9 cases, and C2/3 pedicle-Occiput screw fixation was performed in 1 case. All the patients wore cervical collars as external support for 3 months after the operation.
The mean operative time was 3 h in these patients with a mean intraoperative blood loss of 420 ml. The symptoms were relieved after the surgery in all the patients, who showed no neck pain or neurological defects. The patients were followed up for 6 to 52 months (mean 22 months), and bony fusion was observed in all the 10 cases within 6 to 8 months without such complications as internal fixation failure or redislocation of the atlas.
Patients with Os odontoideum complicated by atlantoaxial dislocation should undergo surgical stabilization to avoid severe neurological injury. Pedicle screw instrument in the atlas allows restoration of the spinal stability, short-segment fusion, and maximal preservation of the mobility of the neck.
总结后路固定融合术治疗齿突游离小骨合并寰枢椎脱位的技术方法并评估其治疗效果。
2007年3月至2010年10月，我院收治10例齿突游离小骨患者（男6例，女4例，年龄20～65岁，平均39.8岁）。术前及术后均行X线、CT及MRI检查，测量并评估脱位及神经受压程度。10例患者均先行1～2周的术前牵引，均显示可复位的寰枢椎脱位。采用后路手术，9例行寰枢椎椎弓根螺钉固定，1例行C2/3椎弓根-枕骨螺钉固定。术后所有患者均佩戴颈托外固定3个月。
患者平均手术时间3小时，平均术中出血量420毫升。术后所有患者症状均缓解，无颈部疼痛或神经功能缺损。患者随访6～52个月（平均22个月），10例均于6～8个月内获得骨性融合，无内固定失败或寰椎再脱位等并发症。
齿突游离小骨合并寰枢椎脱位患者应行手术稳定治疗以避免严重神经损伤。寰椎椎弓根螺钉器械可恢复脊柱稳定性，实现短节段融合，并最大程度保留颈部活动度。
