后路直接复位寰枢外侧关节治疗儿童寰枢椎半脱位：杠杆支点技术。
Posterior Direct Reduction of Lateral Atlantoaxial Joints for Rigid Pediatric Atlantoaxial Subluxation: A Fulcrum Lever Technique.
机构信息
Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan.
Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
出版信息
Spine (Phila Pa 1976). 2020 Sep 1;45(17):E1119-E1126. doi: 10.1097/BRS.0000000000003510.
STUDY DESIGN
Clinical case series.
OBJECTIVE
To present a surgical technique and results of posterior direct reduction of lateral atlantoaxial joints for rigid pediatric atlantoaxial subluxation (AAS) using a fulcrum lever technique.
SUMMARY OF BACKGROUND DATA
The surgical treatment of pediatric rigid AAS is still technically challenging. Several factors contribute to the surgical difficulty, such as small vertebrae, incomplete bone formation, dysplasia, the difficulty of reduction and external fixation are considered as a surgical daunting challenge. Herein, the surgical technique of posterior direct reduction of lateral atlantoaxial joints for rigid pediatric AAS using a fulcrum lever technique is presented.
METHODS
This retrospective study included 10 pediatric patients with rigid AAS who underwent posterior direct reduction of bilateral C1/2 facet joints via a fulcrum lever technique. The indication for surgery was the presence of neurological symptoms and spinal cord atrophy with an intramedullary high signal at the C1 level on T2-weighted magnetic resonance (MR) images. The surgical procedure consisted of three steps: (1) opening and distraction of the C1/2 facet joints and placement of tricortical bone as a spacer and fulcrum; (2) placement of C1 and C2 screws; and finally, (3) compression between the C1 posterior arch and C2 lamina and constructing C1/2 fusion. All patients underwent the neurological and radiological evaluations before and after surgery.
RESULTS
Eight of 10 patients demonstrated genetic disorders, either Down syndrome or chondrodysplasia punctate. Besides, all cases documented congenital anomaly of the odontoid process. Bilateral C1 lateral mass screws were successfully placed in all cases. No evidence of postoperative neurovascular complications. Radiological evaluation showed the corrections and bony fusions of C1/2 facet joint in all cases.
CONCLUSION
The fulcrum lever technique for rigid pediatric AAS can be one of the effective surgical solutions to this challenging pediatric spinal disorder.
LEVEL OF EVIDENCE
研究设计
临床病例系列。
目的
介绍一种使用支点杠杆技术对刚性小儿寰枢关节侧脱位（AAS）进行后路直接寰枢关节外侧关节复位的手术技术和结果。
背景资料概要
小儿刚性 AAS 的手术治疗仍然具有技术挑战性。有几个因素导致手术难度增加，例如小椎体、不完全骨形成、发育不良、复位困难和外固定被认为是手术面临的艰巨挑战。在此，介绍一种使用支点杠杆技术对刚性小儿 AAS 进行后路直接寰枢关节外侧关节复位的手术技术。
方法
本回顾性研究纳入了 10 例刚性 AAS 患儿，均采用支点杠杆技术行双侧 C1/2 关节突关节后路直接复位。手术指征为存在神经症状和脊髓萎缩，T2 加权磁共振（MR）图像上 C1 水平可见髓内高信号。手术过程包括三个步骤：（1）C1/2 关节突关节开口和牵开，放置三叶皮质骨作为间隔和支点；（2）C1 和 C2 螺钉的放置；最后，（3）C1 后弓与 C2 椎板之间的压缩和 C1/2 融合。所有患者均在术前和术后进行神经和影像学评估。
结果
10 例患者中有 8 例存在遗传疾病，要么是唐氏综合征，要么是软骨发育不良点状。此外，所有病例均存在齿状突先天性异常。所有病例双侧 C1 侧块螺钉均成功置入。无术后神经血管并发症证据。影像学评估显示所有病例均矫正并融合 C1/2 关节突关节。
结论
对于刚性小儿 AAS，支点杠杆技术可以成为治疗这种具有挑战性的小儿脊柱疾病的有效手术方法之一。
证据等级
4 级。
Zotero 插件