CAJ | 학술논문

目的探讨Halo架结合枕颈融合术治疗寰枢关节脱位的疗效.方法选取郑州大学第一附属医院骨外科自2008年1月至2012年1月枕颈部畸形所致寰枢关节脱位患者65例,男37例,女28例;年龄17 ～64岁,平均40.6岁;其中39例颅底凹陷,28例寰枕融合,19例Arnold-chiari氏畸形,17例脊髓空洞.术前JOA评分5～10分,平均(7.3±1.7)分,所选取患者均为影像学资料及临床资料完整,均于Halo架固定下行枕颈融合术.术后观察患者临床症状和神经功能改善情况,术前、术后进行JOA评分评定治疗效果.结果患者均顺利完成手术,手术时间150～200 min,平均165 min;术中出血量50～330 ml,平均220 ml;术中均未发生血管、脊髓损伤及其他严重并发症.术后第1天JOA评分7～14分,平均(10.0±2.0)分,较术前明显改善(P＜0.05).术后复查X线片、MRI、CT,所有患者均获得满意复位.随访6～ 48个月,平均22.5个月.末次随访时,JOA评分11 ～ 16分,平均(14.2±1.5)分,较术前及术后第1天均有明显改善(P＜0.05).随访期间1例并发脑梗死死亡,其他患者未发现内固定松动、断裂,并在术后3～6个月内获得骨性愈合.结论 Halo架结合枕颈融合术治疗寰枢关节脱位近期疗效确切,安全可靠.
목적 탐토Halo가결합침경융합술치료환추관절탈위적료효.방법 선취정주대학제일부속의원골외과자2008년1월지2012년1월침경부기형소치환추관절탈위환자65례,남37례,녀28례;년령17 ～64세,평균40.6세;기중39례로저요함,28례환침융합,19례Arnold-chiari씨기형,17례척수공동.술전JOA평분5～10분,평균(7.3±1.7)분,소선취환자균위영상학자료급림상자료완정,균우Halo가고정하행침경융합술.술후관찰환자림상증상화신경공능개선정황,술전、술후진행JOA평분평정치료효과.결과 환자균순리완성수술,수술시간150～200 min,평균165 min;술중출혈량50～330 ml,평균220 ml;술중균미발생혈관、척수손상급기타엄중병발증.술후제1천JOA평분7～14분,평균(10.0±2.0)분,교술전명현개선(P＜0.05).술후복사X선편、MRI、CT,소유환자균획득만의복위.수방6～ 48개월,평균22.5개월.말차수방시,JOA평분11 ～ 16분,평균(14.2±1.5)분,교술전급술후제1천균유명현개선(P＜0.05).수방기간1례병발뇌경사사망,기타환자미발현내고정송동、단렬,병재술후3～6개월내획득골성유합.결론 Halo가결합침경융합술치료환추관절탈위근기료효학절,안전가고.
Objective To investigate the effect of occipitocervical fusion with Halo frame surgical treatment for atlantoaxial dislocation.Methods From January 2008 to January 2012,65 patients(37 males and 28 females) ;with aged 17-64 year old,mean 40.6 year old;suffering from craniocervical malformation were reviewed.All patients had atlantoaxial dislocation,39 patients had basilar invagination,28 patients had occipital-atlas fusion,19 patients had Arnold-chiari' s malformation,17 patients had syringomyelia.The preoperative JOA score were 5-10 points,mean score were (7.3 ± 1.7) points.All patients had the surgical treatment of occipitocervical fusion under fixation of Halo frame,and the integral imaging data and clinical data.Preoperative and follow-up JOA scores were utilized.Results All patients underwent the occipitocervical fusion under fixation of Halo frame successfully without any neurological deficit or vascular injury.The average operative time were 150-200 minutes,mean time were 165minutes ;blood loss were 150-330 ml,an average of 220 ml,no blood vessels,spinal cord injury or other severe complications occured.JOA score of the first day after operation were 7-14 points,mean score were(10.0 ± 2.0)points,which showed signifcant improvement compared with before operation (P ＜0.05).X-ray,MRI and CT after operation showed complete reduction in all patients.The follow-up were 6-48 months,with an average time of 22.5 months.At the last follow-up,JOA score were 11-16 points,mean score were (14.2 ± 1.5) points,which improved significantly than before operation and one day after operation (P ＜ 0.05).During the follow-up,one patient died of cerebral infarction postoperatively,other patients found no implant loosening,fracture,and bone healing was obtained within 3 to 6 months after surgery.Conclusions The occipitocervical fusion with Halo frame surgical treatment for atlantoaxial dislocation is effective,reliable and safe for short-term outcome.