CAJ | 학술논문

目的探讨手术显微镜辅助下经口入路寰枢关节成形术的临床效果. 方法 2009年6月至2011年7月,利用手术显微镜教学观察镜接口自组视频输出系统,应用于经口入路寰枢关节成形术治疗牵引无效的各种难复型寰枢椎脱位患者17例,并对操作过程进行实时录像和视频采集. 结果手术过程顺利,术中利用视频输出系统获得1510万像素高清图像并可获得最高1920×1080像素的高清摄像短片.所有患者均获随访,随访27 ～52个月,平均33个月.17例患者中,症状明显改善者16例,好转者1例.JOA评分由术前(8.1±3.5)分增加到术后2年时的(15.1±1.8)分,根据Hirabayashi方法计算术后改善率,平均改善率78.7％,其中优12例,良5例.颈髓延髓角由术前(128.6±8.5)°增加至术后(151.7±10.4)°;术后X线及CT提示寰、枢椎(G1、G2)序列良好,所有病例术后12个月内后路均获得骨性融合. 结论经口入路寰枢关节成形术是治疗各种难复型寰枢椎脱位的安全有效的手术方式;利用手术显微镜提高了手术的安全性.
목적 탐토수술현미경보조하경구입로환추관절성형술적림상효과. 방법 2009년6월지2011년7월,이용수술현미경교학관찰경접구자조시빈수출계통,응용우경구입로환추관절성형술치료견인무효적각충난복형환추추탈위환자17례,병대조작과정진행실시록상화시빈채집. 결과 수술과정순리,술중이용시빈수출계통획득1510만상소고청도상병가획득최고1920×1080상소적고청섭상단편.소유환자균획수방,수방27 ～52개월,평균33개월.17례환자중,증상명현개선자16례,호전자1례.JOA평분유술전(8.1±3.5)분증가도술후2년시적(15.1±1.8)분,근거Hirabayashi방법계산술후개선솔,평균개선솔78.7％,기중우12례,량5례.경수연수각유술전(128.6±8.5)°증가지술후(151.7±10.4)°;술후X선급CT제시환、추추(G1、G2)서렬량호,소유병례술후12개월내후로균획득골성융합. 결론 경구입로환추관절성형술시치료각충난복형환추추탈위적안전유효적수술방식;이용수술현미경제고료수술적안전성.
Objective To evaluate the clinical efficacy of transoral approach for atlantoaxial joint plasty with operating microscope.Methods Between June 2009 and July 2011,17 patients with various kinds of irreducible atlantoaxial dislocation were treated by the method of transoral for atlantoaxial joint plasty with the microscope and video output system under the direct vision.The operations of the process were in the real-time video and video output.Results All the operative processes were all right.By the video output system assembly,15.1 million pixels high-definition images could be collected and reached 1920 × 1080 pixels vidio camera.All the patients were followed-up for average 33 months(27 to 52 months).Neurological recoverywas significantly improved in 16 cases and took a turn for better in 1 case.The average JOA scores was increased from 8.1 ± 3.5 to 15.1 ± 1.8 at 2 years follow-up.According to Hirabayashi the average improvement rate was 78.7％,and 12 cases were classified as excellent and 5 as good.The cervico-medullary angle was increased from 128.6° ± 8.5° to 151.7° ± 10.4°.All patients gained solid bony fusion with a good alignment of C1 and C2 that were evaluated with postoperative plain X-rays and CT.At 12 months after operation,bony fusions were achieved.Conclusion Atlantoaxial joint plasty is one safe and effective method of managing patients with various kinds of irreducible atlantoaxial dislocation by transoral approach.The miscroscope can improve the safety of surgery.