垂直型寰枢椎脱位患者解剖复位是否优于部分复位？
Is Anatomic Reduction Better Than Partial Reduction in Patients with Vertical Atlantoaxial Dislocation?
作者信息
Wang Qing, Wu Xinjie, Tan Mingsheng, Wang Gaoju, Xu Shuang, Qi Yingna
机构信息
Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China.
出版信息
World Neurosurg. 2018 Jun;114:e301-e305. doi: 10.1016/j.wneu.2018.02.176. Epub 2018 Mar 7.
OBJECTIVE
To describe lower cranial nerve (CN) palsy following vertical overdistraction when performing occipitocervical fusion (OCF) to treat vertical atlantoaxial dislocation (AAD) and basilar invagination (BI) and investigate its possible causes.
METHODS
We report 4 cases with vertical AAD and BI who presented postoperatively with neurogenic dysphagia, dysarthria, and bucking after undergoing anatomic reduction.
RESULTS
Patients underwent revision surgery to achieve partial reduction and demonstrated remarkable recovery of CN IX, X, and XI deficits.
CONCLUSIONS
Performing OCF in the overdistraction position to treat vertical AAD may caudally displace the brainstem relative to the cranial base, resulting in traction injury to the CN IX, X, and XI where they exit the skull base through the jugular foramen.
目的
描述在进行枕颈融合术（OCF）治疗垂直性寰枢椎脱位（AAD）和基底凹陷（BI）时垂直过度撑开后出现的低位颅神经（CN）麻痹，并探讨其可能原因。
方法
我们报告4例垂直性AAD和BI患者，在接受解剖复位后出现神经源性吞咽困难、构音障碍和呛咳。
结果
患者接受翻修手术以实现部分复位，且IX、X和XI颅神经功能缺损明显恢复。
结论
在过度撑开位置进行OCF治疗垂直性AAD可能使脑干相对于颅底向尾侧移位，导致IX、X和XI颅神经在通过颈静脉孔离开颅底处受到牵拉伤。
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