中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2010年
17期
1301-1304
,共4页
尹庆水%夏虹%吴增晖%艾福志%马向阳%章凯%王建华%麦小红%万磊%陈旭琼
尹慶水%夏虹%吳增暉%艾福誌%馬嚮暘%章凱%王建華%麥小紅%萬磊%陳旭瓊
윤경수%하홍%오증휘%애복지%마향양%장개%왕건화%맥소홍%만뢰%진욱경
寰枢关节%脱位%经口入路%内固定
寰樞關節%脫位%經口入路%內固定
환추관절%탈위%경구입로%내고정
Atlanto-axial joint%Dislocation%Transoral approach%Internal fixation
目的 探讨复杂寰枢椎脱位的临床特点和处理方法.方法 回顾性分析自2005年2月至2008年10月收治的54例含有复杂因素、不能有效采取常规治疗方法的复杂寰枢椎脱位患者的临床特点和复杂因素,其中男性26例,女性28例,年龄4～65岁,平均34岁.根据不同的复杂因素采取不同的特殊处理方法,主要包括Ⅲ型经口寰枢椎复位钢板(TARP-Ⅲ)内固定术、计算机辅助设计与快速成型(CAD-RP)指导下的深部磨削减压技术、CAD-RP个性化置钉导板技术及经口扩大入路技术.结果 平均随访时间24个月,54例患者中48例获得解剖复位,6例接近解剖复位;受压颈髓减压充分,脊髓减压改善率达86.0%,神经功能改善率达77.8%.2例术后发生颅内感染,均治愈.结论 通过应用TARP-Ⅲ手术、CAD-RP指导下的深部磨削减压操作技术、CAD-RP个性化置钉导板技术和扩大手术人路等四项技术,一些复杂的寰枢椎脱位患者能够得到有效治疗.
目的 探討複雜寰樞椎脫位的臨床特點和處理方法.方法 迴顧性分析自2005年2月至2008年10月收治的54例含有複雜因素、不能有效採取常規治療方法的複雜寰樞椎脫位患者的臨床特點和複雜因素,其中男性26例,女性28例,年齡4～65歲,平均34歲.根據不同的複雜因素採取不同的特殊處理方法,主要包括Ⅲ型經口寰樞椎複位鋼闆(TARP-Ⅲ)內固定術、計算機輔助設計與快速成型(CAD-RP)指導下的深部磨削減壓技術、CAD-RP箇性化置釘導闆技術及經口擴大入路技術.結果 平均隨訪時間24箇月,54例患者中48例穫得解剖複位,6例接近解剖複位;受壓頸髓減壓充分,脊髓減壓改善率達86.0%,神經功能改善率達77.8%.2例術後髮生顱內感染,均治愈.結論 通過應用TARP-Ⅲ手術、CAD-RP指導下的深部磨削減壓操作技術、CAD-RP箇性化置釘導闆技術和擴大手術人路等四項技術,一些複雜的寰樞椎脫位患者能夠得到有效治療.
목적 탐토복잡환추추탈위적림상특점화처리방법.방법 회고성분석자2005년2월지2008년10월수치적54례함유복잡인소、불능유효채취상규치료방법적복잡환추추탈위환자적림상특점화복잡인소,기중남성26례,녀성28례,년령4～65세,평균34세.근거불동적복잡인소채취불동적특수처리방법,주요포괄Ⅲ형경구환추추복위강판(TARP-Ⅲ)내고정술、계산궤보조설계여쾌속성형(CAD-RP)지도하적심부마삭감압기술、CAD-RP개성화치정도판기술급경구확대입로기술.결과 평균수방시간24개월,54례환자중48례획득해부복위,6례접근해부복위;수압경수감압충분,척수감압개선솔체86.0%,신경공능개선솔체77.8%.2례술후발생로내감염,균치유.결론 통과응용TARP-Ⅲ수술、CAD-RP지도하적심부마삭감압조작기술、CAD-RP개성화치정도판기술화확대수술인로등사항기술,일사복잡적환추추탈위환자능구득도유효치료.
Objective To explore the clinical characteristics and treatment methods for complicated atlantoaxial dislocation.Methods A retrospective evaluation was done to summarize and analyze the clinical characteristics and complicated factors of 54 patients with complicated atlantoaxial dislocation who could not to be treated effectively by using conventional therapy in our hospital from February 2005 to October 2008.According to different complicated factors,different treatment methods mainly including transoral atlantoaxial reduction plate-Ⅲ(TARP-Ⅲ)operation,decompression procedure with deep grinding guided by computer aided design-rapid prototyping(CAD-RP),screw placement technique with CAD-RP guideplate and extensile approach surgery were performed.Results The average follow-up period was 24 months.Among 54 cases,48 cases achieved immediate anatomic reduction completely and 6 cases almost achieved anatomical reduction.All the compressed spinal cords were decompressed sufficiently.The decompression rate was 86.0%and the improvement rate of nerve function was 77.8%.Two cases suffered postoperative intracranial infection.Conclusion Some cases of complicated atlantoaxial dislocation can be effectively treated by using TARP-Ⅲ operation,decompression procedure with deep grinding guided by CAD-RP,individualized screw placement technique with CAD-RP guide plate and extensile approach surgery.
