Song Hui, Li Hao-Peng, Zang Quan-Jin, He Xi-Jing
Department of Orthopaedics, the 2nd Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China.
Department of Orthopaedics, the 2nd Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China;
Zhongguo Gu Shang. 2016 Oct 25;29(10):878-882. doi: 10.3969/j.issn.1003-0034.2016.10.002.
To retrospectively analyze the surgical methods and its clinical effects and explore a clinical classification and treatment strategy for atlantoaxial dislocation(AAD).
The clinical data of 89 patients with atlantoaxial dislocation were analyzed from September 2005 to September 2013. There were 49 males and 40 females, aged from 13 to 67 years with an average of 48.1 years. According to the reductive effects with preoperative cervical dynamic radiograph and high weight skeletal traction under general anesthesia, the dislocations were classified into three types:easy reduction type, hard reduction type and irreducible type. The patients with easy reduction type were treated with posterior screw rod internal fixation after manual reduction, while the patients with hard reduction type were treated with posterior screw rod fixation after high weight skeletal traction reduction under general anesthesia. The patients with irreducible type were treated with transoral atlantoaxial joint release or depression and posterior internal fixation and fusion. According to JOA scores to evaluate the neurological status and treatment outcome.
Thirty patients were classified as easy reduction type, 55 patients as hard reduction type, and 4 patients as irreducible type. The preoperative JOA score was 8.2±3.1 on average, while the postoperative score was 14.2±2.4. The improvement rate was 40.1% to 82.5% with an average of 62.5%. Eighty nine patients were followed up from 6 to 37 months with a mean of 17.3 months. Eighty two cases obtained anatomical reduction and 85 cases obtained bony fusion. One case complicated with hyponatremia after operation and 1 case combined with Guillain-Barre syndrome, 4 cases complicated with delayed union wounds, 1 case died of for respiratory failure 2 years after operation. No wound infections were found in the patients approach for transoral operation.
According to the cervical dynamic radiograph and high weight skeletal traction under general anesthesia to classify for atlantoaxial dislocation, and adopting well strategies to treat the patients, can achieve satisfactory effects.
回顾性分析寰枢椎脱位（AAD）的手术方法及其临床效果，探讨其临床分型及治疗策略。
分析2005年9月至2013年9月收治的89例寰枢椎脱位患者的临床资料。其中男49例，女40例，年龄13～67岁，平均48.1岁。根据术前颈椎动力位X线片及全麻下大重量颅骨牵引复位情况，将脱位分为3型：易复位型、难复位型和不可复位型。易复位型患者手法复位后行后路螺钉棒内固定，难复位型患者全麻下大重量颅骨牵引复位后行后路螺钉棒固定，不可复位型患者行前路经口寰枢关节松解或减压及后路内固定融合术。根据日本骨科学会（JOA）评分评估神经功能状态及治疗效果。
易复位型30例，难复位型55例，不可复位型4例。术前JOA评分平均为（8.2±3.1）分，术后为（14.2±2.4）分。改善率为40.1%～82.5%，平均62.5%。89例患者随访6～37个月，平均17.3个月。82例获得解剖复位，85例获得骨性融合。1例术后并发低钠血症，1例合并吉兰-巴雷综合征，4例伤口延迟愈合，1例术后2年因呼吸衰竭死亡。经口手术患者未发生伤口感染。
根据颈椎动力位X线片及全麻下大重量颅骨牵引对寰枢椎脱位进行分型，并采取相应的治疗策略，可取得满意疗效。
