CAJ | 학술논문

目的：通过临床病例分析探讨不稳定性齿突游离小骨的临床特点及后路融合手术的治疗效果。方法回顾性分析2005年5月～2012年5月本院采用手术治疗有临床症状的不稳定性齿突游离小骨患者26例。分析总结病史特点、临床表现、影像学表现及手术治疗效果。结果26例患者中男16例，女10例。年龄36～66岁，平均43．3岁。15例既往有明确外伤史，21例患者有颈部症状，所有患者均有不同程度的神经损伤症状，术前神经功能日本骨科学会（ Japanese Orthopaedic Association ，JOA）评分8～15分，平均10．1分。所有患者影像学均有寰枢椎脱位表现，其中22例为可复性，有2例伴有上颈椎其他畸形。24例行后路寰枢椎融合术，2例行枕颈融合术，术中无椎动脉、脊髓损伤发生，术后平均随访26个月（12～36个月），26例患者均达到骨性融合，无内固定松动、断裂等并发症。术后12个月，颈部症状及神经功能明显改善， JOA评分为12～17分，平均15．1分（ P＜0．05）。结论不稳定性齿突游离小骨容易损伤脊髓，应尽早手术重建其稳定性，经后路融合手术安全有效。
목적：통과림상병례분석탐토불은정성치돌유리소골적림상특점급후로융합수술적치료효과。방법회고성분석2005년5월～2012년5월본원채용수술치료유림상증상적불은정성치돌유리소골환자26례。분석총결병사특점、림상표현、영상학표현급수술치료효과。결과26례환자중남16례，녀10례。년령36～66세，평균43．3세。15례기왕유명학외상사，21례환자유경부증상，소유환자균유불동정도적신경손상증상，술전신경공능일본골과학회（ Japanese Orthopaedic Association ，JOA）평분8～15분，평균10．1분。소유환자영상학균유환추추탈위표현，기중22례위가복성，유2례반유상경추기타기형。24례행후로환추추융합술，2례행침경융합술，술중무추동맥、척수손상발생，술후평균수방26개월（12～36개월），26례환자균체도골성융합，무내고정송동、단렬등병발증。술후12개월，경부증상급신경공능명현개선， JOA평분위12～17분，평균15．1분（ P＜0．05）。결론불은정성치돌유리소골용역손상척수，응진조수술중건기은정성，경후로융합수술안전유효。
Objective To analyze the clinical characteristics of unstable os odontoideum and determine the efficiency of the treatment by retrospective study .Methods From May 2005 to May 2012, 26 patients with unstable os odontoideum were treated by posterior fusion .The clinical characteristics , clinical feature , imaging manifestations and therapeutic effect of oper-ation were analyzed .Results Among 26 patients, 16 patients were males and 10 females, the mean age was 43.3 years (range 36-66 years).There was a history of significant , previous trauma in 15 patients.And 21 patients presented neck pain. Neurological signs and symptoms of myelopathy were present in all patients and the mean Japanese Orthopaedic Association (JOA) score was 10.1(8-15).Atlantoaxial dislocation were found in all patients .Posterior atlantoaxial fusion was performed in 24 patients and occipitocervical fusion in 2 patients.All patients were followed up for 12 to 36 months ( average, 26 months) .All patients gained solid bony fusion .No vertebral artery or spinal cord injuries caused by operative procedure oc-curred.There was no fixator failure during the follow-up period.One year later, All patients had a relief of local symptoms and neurological symptoms , the mean JOA score was 15.1(12-17).Conclusion Patients with unstable os odontoideum are at risk of spinal cord injury.Posterior fusion allows restoration of the spinal stability and can get effective results and less compli -cations.