CAJ | 학술논문

目的分析颅颈交界畸形中寰枢椎脱位的特点,探讨其手术策略制定.方法分析2009年4月至2011年11月手术治疗的56例颅颈交界畸形伴寰枢椎脱位患者资料,包括2例可复性脱位和54例难复性脱位；其中男性22例,女性34例,年龄9 ～56岁,平均34岁.14例采用后路固定达到直接复位或部分复位,41例进行了经口前路减压和后路固定融合术,1例经后路行齿状突磨除和固定融合术.结果 53例患者获得随访,3例失访(出院时症状较术前改善)；随访时间6 ～36个月,平均20个月.术后7例患者出现并发症,包括脑脊液漏2例、肺部感染2例、局部肉芽肿样病变1例、切口延期愈合1例,经对症处理后均恢复；1例出现不可逆性颈髓损伤,遗留四肢肌力下降.末次随访时Nurick分级,6例(11.3％)较术前改善3级,30例(56.6％)改善2级,13例(24.5％)改善1级,3例(5.7％)无明显改善,1例(1.9％)加重.结论可复性寰枢椎脱位行后路固定即可达到复位效果,难复性寰枢椎脱位治疗方式要个体化,依据病情、影像学表现和临床经验采用直接复位固定术或经口齿状突磨除及后路固定融合术.
목적 분석로경교계기형중환추추탈위적특점,탐토기수술책략제정.방법 분석2009년4월지2011년11월수술치료적56례로경교계기형반환추추탈위환자자료,포괄2례가복성탈위화54례난복성탈위；기중남성22례,녀성34례,년령9 ～56세,평균34세.14례채용후로고정체도직접복위혹부분복위,41례진행료경구전로감압화후로고정융합술,1례경후로행치상돌마제화고정융합술.결과 53례환자획득수방,3례실방(출원시증상교술전개선)；수방시간6 ～36개월,평균20개월.술후7례환자출현병발증,포괄뇌척액루2례、폐부감염2례、국부육아종양병변1례、절구연기유합1례,경대증처리후균회복；1례출현불가역성경수손상,유류사지기력하강.말차수방시Nurick분급,6례(11.3％)교술전개선3급,30례(56.6％)개선2급,13례(24.5％)개선1급,3례(5.7％)무명현개선,1례(1.9％)가중.결론 가복성환추추탈위행후로고정즉가체도복위효과,난복성환추추탈위치료방식요개체화,의거병정、영상학표현화림상경험채용직접복위고정술혹경구치상돌마제급후로고정융합술.
Objectives To analyze the clinical characteristics of the atlantoaxial dislocation (AAD) in craniovertebral junction (CVJ)abnormalities and to study the setup of its surgery strategy.Methods From April 2009 to November 2011,56 patients of AAD and CVJ abnormalities including 22 male and 34 female patients who had received surgery were analyzed.There were 2 cases of reducible AAD and 54 cases of irreducible AAD.The age of the patients ranged from 9 to 56 years (mean 34 years).Among them,14 cases achieved reduction/partial reduction via direct posterior fixation,41 cases had transoral anterior deconpression and occipito-cervicaL/C1-C2 fusion and 1 case had the posterior odontoidectomy and spinal fusion.Results Fifty-three cases had a follow-up between 6 months and 36 months (mean 20 months) and 3 cases lost follow-up (had improvement at discharge).Seven cases had complications as follows:1 case had irreversible spinal cord injury and muscle weakness of extremities,2 cases had cerebrospinal leak,2 cases had pulmonary infection,1 case had local granuloma hyperplasia and 1 case had delayed healing of the incision.The later 6 eases all got recovery after reasonable treatments.The grades of Nurick at last follow-up were as follows:6 cases (11.3％) improved by 3 grades,30 cases(56.6％)improved by 2 grades,13 cases (24.5％) improved by 1 grade,3 cases (5.7％) without change,1 case (1.9％) get worse.Conclusions Reducible AAD could achieve direct reduction and fixation via posterior pathways.Irreducible AAD needs individualized treatment.To choose the direct reduction and fixation or transoral odontoidectomy and posterior fixation and fusion should consider the pathogenetic condition,the image data and personal clinical experience.