Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, People's Republic of China.
Department of Neurosurgery, The People's Hospital of Guizhou Province, Guiyang, People's Republic of China.
Eur Spine J. 2019 May;28(5):1053-1063. doi: 10.1007/s00586-018-05869-z. Epub 2019 Jan 2.
Surgical procedures on atlantoaxial dislocation remain controversial. The aim of this observational retrospective study was to investigate the treatment algorithm of surgical procedures.
According to CT and intraoperative evaluation during direct posterior reduction, 135 AAD cases were categorized into three groups: Group I: reducible dislocation; Group II: irreducible dislocation (Group IIa: effective decompression achieved after posterior reduction; Group IIb: no effective decompression after posterior reduction); and Group III: fixed dislocation. Group III presented with extensive bony fusions. Group I and Group IIa were treated with direct posterior reduction and fixation. Group IIb underwent posterior fixation and transoral odontoidectomy. Group III underwent transoral odontoidectomy alone. Japanese Orthopedic Association scores (JOA) were assessed to evaluate clinical status before and 6, 12 months after surgery.
Our study included 118 Group I cases, 16 Group II cases (Group IIa: 11 cases; Group IIb: 5 cases), and one Group III case. Follow-up ranged from 12 to 36 months.
Anatomic atlantoaxial reduction was achieved in 118 of 135 patients (87.4%). Clinical improvements were seen in 96.3% (130/135) all the patients. Solid atlantoaxial fusion was shown in 134 patients. Secondary outcome: The overall complication rate was 3.7% (5/135). For Group I, the mean postoperative 6-month JOA was 14.5 versus 12.2 in preoperative patients (paired Student's t test, P < 0.01).
This article proposes a clinical procedure that assists with therapeutic decision making and indicates the severity and difficulty of reduction of the atlantoaxial joint. These slides can be retrieved under Electronic Supplementary Material.
寰枢关节脱位的手术治疗仍存在争议。本观察性回顾性研究旨在探讨手术治疗方案。
根据 CT 及直接后路复位术中评估，将 135 例寰枢关节脱位患者分为三组：Ⅰ组：可复性脱位；Ⅱ组：不可复性脱位（Ⅱa 组：后路复位后减压有效；Ⅱb 组：后路复位后减压无效）；Ⅲ组：固定性脱位。Ⅲ组表现为广泛的骨融合。Ⅰ组和Ⅱa 组行直接后路复位和固定术。Ⅱb 组行后路固定和经口齿状突切除术。Ⅲ组仅行经口齿状突切除术。采用日本骨科协会评分（JOA）评估手术前后 6、12 个月的临床状况。
本研究纳入 118 例Ⅰ组病例、16 例Ⅱ组病例（Ⅱa 组 11 例，Ⅱb 组 5 例）和 1 例Ⅲ组病例。随访时间为 12-36 个月。
135 例患者中 118 例（87.4%）达到解剖复位。所有患者中 96.3%（130/135）的临床症状均有改善。134 例患者寰枢关节融合牢固。次要结局：总并发症发生率为 3.7%（5/135）。Ⅰ组患者术后 6 个月的平均 JOA 为 14.5，术前为 12.2（配对学生 t 检验，P<0.01）。
本文提出了一种有助于治疗决策的临床方案，并指出了寰枢关节复位的严重程度和难度。这些幻灯片可在电子补充材料中检索。
