中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2013年
9期
884-887
,共4页
乔广宇%张远征%余新光%佟怀宇%周定标%许百男
喬廣宇%張遠徵%餘新光%佟懷宇%週定標%許百男
교엄우%장원정%여신광%동부우%주정표%허백남
内固定%寰椎%寰枕融合%寰枢椎脱位%Goel技术
內固定%寰椎%寰枕融閤%寰樞椎脫位%Goel技術
내고정%환추%환침융합%환추추탈위%Goel기술
Internal fixators%Atlas%Occipitalization%Atlanto-axial dislocations%Goel method
目的 探讨应用Goel技术(即应用C1侧块-C2椎弓峡部螺钉-棒内固定器械行C1~2侧块关节复位、固定和植骨融合)手术治疗合并寰枕融合的寰枢椎脱位的可行性及临床疗效.方法 回顾性分析138例2009年11月至2013年3月间解放军总医院神经外科收治并手术的颅底凹陷合并寰枢椎关节脱位患者的临床资料.男61例,女77例;年龄7~65岁,平均37.3岁.所有病例均采用经寰椎侧块螺钉和枢椎椎弓峡部螺钉或下关节突螺钉棒内固定系统行C1~2侧块关节复位固定,于髂后上嵴取松质骨颗粒植骨融合.结果 138例中136例获得满意临床治疗效果,2例出现严重并发症,其中1例死亡.根据出院前颈椎3D-CT结果评判,54例完全复位,83例部分复位.87例得到3个月以上时间随访,未出现断钉、断棒现象,其中85例内固定稳固,植骨愈合,2例随访时发现内固定松动做了翻修手术,重新植骨融合.87例随访患者功能评价(Odom评级):优35例,良50例,可2例,差0例.结论 应用Goel内固定技术对寰枢椎侧块关节复位、固定及植骨融合治疗畸形寰枢椎脱位安全可行,疗效满意.
目的 探討應用Goel技術(即應用C1側塊-C2椎弓峽部螺釘-棒內固定器械行C1~2側塊關節複位、固定和植骨融閤)手術治療閤併寰枕融閤的寰樞椎脫位的可行性及臨床療效.方法 迴顧性分析138例2009年11月至2013年3月間解放軍總醫院神經外科收治併手術的顱底凹陷閤併寰樞椎關節脫位患者的臨床資料.男61例,女77例;年齡7~65歲,平均37.3歲.所有病例均採用經寰椎側塊螺釘和樞椎椎弓峽部螺釘或下關節突螺釘棒內固定繫統行C1~2側塊關節複位固定,于髂後上嵴取鬆質骨顆粒植骨融閤.結果 138例中136例穫得滿意臨床治療效果,2例齣現嚴重併髮癥,其中1例死亡.根據齣院前頸椎3D-CT結果評判,54例完全複位,83例部分複位.87例得到3箇月以上時間隨訪,未齣現斷釘、斷棒現象,其中85例內固定穩固,植骨愈閤,2例隨訪時髮現內固定鬆動做瞭翻脩手術,重新植骨融閤.87例隨訪患者功能評價(Odom評級):優35例,良50例,可2例,差0例.結論 應用Goel內固定技術對寰樞椎側塊關節複位、固定及植骨融閤治療畸形寰樞椎脫位安全可行,療效滿意.
목적 탐토응용Goel기술(즉응용C1측괴-C2추궁협부라정-봉내고정기계행C1~2측괴관절복위、고정화식골융합)수술치료합병환침융합적환추추탈위적가행성급림상료효.방법 회고성분석138례2009년11월지2013년3월간해방군총의원신경외과수치병수술적로저요함합병환추추관절탈위환자적림상자료.남61례,녀77례;년령7~65세,평균37.3세.소유병례균채용경환추측괴라정화추추추궁협부라정혹하관절돌라정봉내고정계통행C1~2측괴관절복위고정,우가후상척취송질골과립식골융합.결과 138례중136례획득만의림상치료효과,2례출현엄중병발증,기중1례사망.근거출원전경추3D-CT결과평판,54례완전복위,83례부분복위.87례득도3개월이상시간수방,미출현단정、단봉현상,기중85례내고정은고,식골유합,2례수방시발현내고정송동주료번수수술,중신식골융합.87례수방환자공능평개(Odom평급):우35례,량50례,가2례,차0례.결론 응용Goel내고정기술대환추추측괴관절복위、고정급식골융합치료기형환추추탈위안전가행,료효만의.
Objective To explore the surgical feasibility and clinical outcome of C1 lateral mass-C2 pars articular screw fixation (Goel's method) in the treatment of atlantoaxial dislocation combined with C1 assimilation.Methods 138 patients were diagnosed basilar impression with atlantoaxial dislocation and C1 assimilation.All of the patients underwent the posterior operation of open reduction and arthrodesis with C1,2 joint fixations with rods,and screws in the lateral masses and pars articulars of the atlas and axis.Results Complete reduction was achieved in 54 cases,83 patients obtained partial reduction,87 patients were followed up more than 3 months,85 cases achieved solid fixation and arthrodesis,and 2 cases appeared internal instruments loosened and underwent revised surgery.According to Odom's scoring system,among the 87 patients with preoperative upper cervical myelopathy,35 patients were assessed as excellent,50 good,2 fair,and 0 poor.One patient exploded respiration and cardiac arrest at 12 hours post operation.Conclusions Posterior reduction and arthrodeses with rigid internal fixators by the Goel method could achieve satisfactory outcomes in patients with atlantoaxial dislocation.