CAJ | 학술논문

背景：经口前路松解后路融合内固定已成为治疗难复性寰枢关节脱位的主流治疗方法，但目前还缺乏长期疗效观察。 　　目的：观察经口前路松解后路融合及钉棒置入内固定治疗难复性寰枢关节脱位的临床疗效。 　　方法：经口前路松解后路融合内固定治疗难复性寰枢关节脱位患者32例，治疗后行颈椎正侧位数字化DR及颈椎MRI影像学检查了解神经压迫解除情况和骨性融合情况；治疗前、治疗后6个月及末次随访时采用JOA评分评定患者神经功能恢复情况。 　　结果与结论：治疗后29例获得随访，平均随访12个月。①所有患者均获得良好的寰枢关节复位和骨性融合，实现了复位与重建脊柱稳定性的双重目的。②所有患者治疗后脊髓受压明显减轻，神经功能均获得不同程度改善，治疗后6个月及末次随访JOA评分与治疗前比较，差异均有显著性意义(P <0.05)。③所有患者治疗过程中均无脊髓、椎动脉损伤等严重并发症发生，治疗后无感染、破溃等并发症发生。④影像学检查显示，经口前路松解后路融合内固定是治疗难复性寰枢关节脱位的一种安全有效的方法。
배경：경구전로송해후로융합내고정이성위치료난복성환추관절탈위적주류치료방법，단목전환결핍장기료효관찰。 　　목적：관찰경구전로송해후로융합급정봉치입내고정치료난복성환추관절탈위적림상료효。 　　방법：경구전로송해후로융합내고정치료난복성환추관절탈위환자32례，치료후행경추정측위수자화DR급경추MRI영상학검사료해신경압박해제정황화골성융합정황；치료전、치료후6개월급말차수방시채용JOA평분평정환자신경공능회복정황。 　　결과여결론：치료후29례획득수방，평균수방12개월。①소유환자균획득량호적환추관절복위화골성융합，실현료복위여중건척주은정성적쌍중목적。②소유환자치료후척수수압명현감경，신경공능균획득불동정도개선，치료후6개월급말차수방JOA평분여치료전비교，차이균유현저성의의(P <0.05)。③소유환자치료과정중균무척수、추동맥손상등엄중병발증발생，치료후무감염、파궤등병발증발생。④영상학검사현시，경구전로송해후로융합내고정시치료난복성환추관절탈위적일충안전유효적방법。
BACKGROUND:Transoral ventral release and posterior fusion have predominated in the treatment of irreducible atlantoaxial dislocation, but there is no consistent conclusion on the clinical efficacy. OBJECTIVE:To explore the clinical outcomes of transoral ventral release and posterior fusion and screw/rod implantation in the treatment of irreducible atlantoaxial dislocation. METHODS:A total of 32 patients with irreducible atlantoaxial dislocation undergoing thetransoral ventral release and posterior fusion were selected. After treatment, they received cervical anteroposterior and lateral digital DR and cervical MRI examinations to understand the conditions of nerve compression and bone fusion. The recovery of nerve function was evaluated using Japanese Orthopaedic Association before treatment, 6 months after treatment and during final fol ow-up. RESULTS AND CONCLUSION:Post-treatment, 29 patients were fol owed-up for an average period of 12 months. (1) Al the patients obtained perfect atlantoaxial joint reduction and bone fusion. This achieved reduction and reconstruction of spinal column stability. (2) Spinal compression was obviously lessened after treatment in al patients, and nerve functions were improved to different degrees. Significant differences in Japanese Orthopaedic Association score were detected between 6 months post-treatment, final fol ow-up and pre-treatment (P<0.05). (3) There were no serious intraoperative complications such as spinal cord or vertebral artery injuries. Postoperative complications such as infection or burst were also not found. (4) Imaging evaluation revealed that transoral ventral release and posterior fusion is safe and effective for treatment of irreducible atlantoaxial dislocation.