Subin B, Liu J F, Marshall G J, Huang H Y, Ou J H, Xu G Z
J. Vernon Luck, Sr, MD Orthopaedic Research Center, Orthopaedic Hospital of Los Angeles, USA.
Spine (Phila Pa 1976). 1995 Jun 1;20(11):1233-40. doi: 10.1097/00007632-199506000-00004.
In this study, 10 patients with chronic irreducible atlantoaxial dislocation were treated by transoral anterior decompression and fusion.
To examine the benefits of the transoral approach, the patients treated with this procedure were compared with the historical control subjects after 2 years of follow-up.
Chronic irreducible atlantoaxial dislocation with cord compression is difficult to treat because the cord is compressed posteriorly by the posterior arch of the atlas as well as anteriorly by the posterior-superior portion of the axial body and nonunited dens. Its irreducibility, as a result of the bony scarring between the dens and the anterior body of the axis, and the locking of the lateral joints of C1-C2, makes reduction more complex. Posterior surgical approaches have been associated with high morbidity and mortality.
Ten patients were diagnosed and followed up by clinical symptoms, radiography, pantopaque myelography, and computed tomography. They were treated surgically by transoral decompression and fusion. During the surgery the nonunited dens as well as callus, granulation, and scar tissue were removed; the cartilage of the articular surfaces of the atlantoaxial joint was excised. Postoperative treatment included skull-cervical biaxial traction, tracheostomy care, nasal feeding, and Minerva cast.
The 2- to 6-year follow-up showed that four out of 10 patients recovered completely and returned to work, three recovered to a great degree and ambulated, two partially recovered, and one recovered poorly.
Transoral decompression and fusion offered satisfactory results in a series of patients with chronic irreducible atlantoaxial dislocation. None of the patients showed serious complications of stability, even though only one had a secondary posterior fusion. Therefore, anterior decompression associated with subtotal obliteration of the atlantoaxial joints without bone grafts is a feasible therapy for irreducible atlantoaxial dislocation using a multifunctional bed and biaxial traction.
在本研究中，10例慢性难复性寰枢椎脱位患者接受了经口前路减压融合术治疗。
为探讨经口入路的益处，对接受该手术治疗的患者进行2年随访，并与历史对照受试者进行比较。
伴有脊髓压迫的慢性难复性寰枢椎脱位难以治疗，因为脊髓受到寰椎后弓的后方压迫，以及枢椎体后上部和齿突不连的前方压迫。由于齿突与枢椎体前方之间的骨瘢痕形成以及C1-C2侧方关节的锁定，其难复性使得复位更加复杂。后路手术方法与高发病率和死亡率相关。
10例患者通过临床症状、X线摄影、碘苯酯脊髓造影和计算机断层扫描进行诊断和随访。他们接受了经口减压融合手术治疗。手术中切除了不连的齿突以及骨痂、肉芽组织和瘢痕组织；切除了寰枢关节关节面的软骨。术后治疗包括头颈部双轴牵引、气管切开护理、鼻饲和密涅瓦石膏固定。
2至6年的随访显示，10例患者中有4例完全康复并重返工作岗位，3例大部分康复并能行走，2例部分康复，1例康复不佳。
经口减压融合术在一系列慢性难复性寰枢椎脱位患者中取得了满意的效果。即使只有1例患者进行了二期后路融合，也没有患者出现严重的稳定性并发症。因此，使用多功能床和双轴牵引，在不进行植骨的情况下，对寰枢关节进行次全切除并联合前路减压，是治疗难复性寰枢椎脱位的一种可行方法。
