中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2008年
4期
280-282
,共3页
尹庆水%昌耘冰%夏虹%吴增晖%艾福志%权日%马向阳%章凯%曹正霖%王建华
尹慶水%昌耘冰%夏虹%吳增暉%艾福誌%權日%馬嚮暘%章凱%曹正霖%王建華
윤경수%창운빙%하홍%오증휘%애복지%권일%마향양%장개%조정림%왕건화
寰椎%枢椎%脱位%分类法
寰椎%樞椎%脫位%分類法
환추%추추%탈위%분류법
Atlas%Axis%Dislocations%Classification
目的 探讨寰枢关节脱位的综合分型及治疗策略.方法 在病因分型的基础上结合Fielding影像学分型和临床分型拟定和采用了寰枢关节脱位的综合分型,简称PIR分型.根据此综合分型系统对93例寰枢关节脱位患者进行分型和治疗.结果 9例齿突Ⅱ型骨折采用中空螺钉直接固定,术后3个月愈合,颈椎功能轻度受限;1例仍有Fielding Ⅰ度移位.34例经口咽前路寰枢椎复位钢板内固定术(TARP),其中32例术后3个月关节复位融合良好,2例螺钉松动再脱位,经翻修手术愈合.4例行前和(或)后路减压术后神经症状改善,但未能复位,其中1例发生颅内感染.结论 PIR分型表达了寰枢关节脱位病因、影像学和力学稳定性三个方面的因素和特征,对临床治疗具有指导意义.TARP手术和后路寰枢椎弓根钉杆固定是治疗寰枢椎脱位的主要手段.
目的 探討寰樞關節脫位的綜閤分型及治療策略.方法 在病因分型的基礎上結閤Fielding影像學分型和臨床分型擬定和採用瞭寰樞關節脫位的綜閤分型,簡稱PIR分型.根據此綜閤分型繫統對93例寰樞關節脫位患者進行分型和治療.結果 9例齒突Ⅱ型骨摺採用中空螺釘直接固定,術後3箇月愈閤,頸椎功能輕度受限;1例仍有Fielding Ⅰ度移位.34例經口嚥前路寰樞椎複位鋼闆內固定術(TARP),其中32例術後3箇月關節複位融閤良好,2例螺釘鬆動再脫位,經翻脩手術愈閤.4例行前和(或)後路減壓術後神經癥狀改善,但未能複位,其中1例髮生顱內感染.結論 PIR分型錶達瞭寰樞關節脫位病因、影像學和力學穩定性三箇方麵的因素和特徵,對臨床治療具有指導意義.TARP手術和後路寰樞椎弓根釘桿固定是治療寰樞椎脫位的主要手段.
목적 탐토환추관절탈위적종합분형급치료책략.방법 재병인분형적기출상결합Fielding영상학분형화림상분형의정화채용료환추관절탈위적종합분형,간칭PIR분형.근거차종합분형계통대93례환추관절탈위환자진행분형화치료.결과 9례치돌Ⅱ형골절채용중공라정직접고정,술후3개월유합,경추공능경도수한;1례잉유Fielding Ⅰ도이위.34례경구인전로환추추복위강판내고정술(TARP),기중32례술후3개월관절복위융합량호,2례라정송동재탈위,경번수수술유합.4례행전화(혹)후로감압술후신경증상개선,단미능복위,기중1례발생로내감염.결론 PIR분형표체료환추관절탈위병인、영상학화역학은정성삼개방면적인소화특정,대림상치료구유지도의의.TARP수술화후로환추추궁근정간고정시치료환추추탈위적주요수단.
Objective To evaluate the synthetic typing and the treatment strategy for atlantoaxial dislocation.Methods The synthetic typing of atlantoaxial dislocation was worked out on the base of pathogenesis typing,Fielding imaging typing,and clinical typing,named PIR typing system(Pathogenesis,Imaging,and Reduction). Ninety-three patients with atlantoaxial dislocation were treated according to this typing system. Results Nine cases of type-Ⅱ dens fracture were treated with canulated screw fixation.Bone union was accomplished at the follow-up of three months in all the patients, only with slight limitation of cervical motion.Unretrieved Fielding Ⅰ-degree dislocation was found in one case. Among the thirty-four patients treated with transoropharyngeal atlantoaxial reduction plate system(TARP),32 obtained complete atlantoaxial reduction and fusion three months after operation.Atlantoaxial dislocation recurred in the other two cases because of screw loosening and the problem was solved through revision operations. Four patients in unreducible type underwent anterior and/or posterior decompression. Their neurological symptoms improved after operation but their atlantoaxial. Joints remained dislocated,and one case conplicated with intracranial infection.Conclusions Via the synthetic PIR typing system,atlantoaxial dislocafton can be better classified according to its pathogenesis,imaging manifestation and mechanic stability. This system can also be served as a guide for clinical treatment. Anterior TARP operation and posterior atlantoaxial transpedical screw-rod fixation are the main methods for the treatment of aflantoaxial dislocation.
