摘要
目的:寻找一种概念明确的寰枢椎脱位的外科分型方法,为临床处理脱位提供指导方案。方法:总结三家医院收治的168例不同病因所致C1-2脱位患者的临床资料,根据脱位的复位情况将其分为3型:(1)牵引复位型(tractionreductiontype,T型),该型又以复位后的稳定性不同分为T1和T2型;(2)手术复位型(operationreductiontype,O型);(3)不可复位型(irreducibletype,I型)。简称TOI分型。T1型采用牵引或支具治疗8～10周;T2型采用牵引复位后固定融合(其中6例只行C1-2临时固定,不行融合);O型采用前路松解+后路复位固定融合;I型实施减压原位固定融合。根据Symon和Lavender临床标准、JOA脊髓功能评定标准和影像学测量C1-2脊髓有效空间(spaceavailableforthecord,SAC)进行疗效评定。结果:168例中,T型137例(81%),其中T1型71例(43%),T2型66例(38%);O型28例(17%);I型3例(2%)。术前SAC为3～13mm,平均8mm,术后为11～19mm,平均16mm。术后脊髓功能改善率平均为64.7%;临床有效率为88.7%。T型病例中77例未融合固定者愈合后仍保留C1-2活动功能。结论:寰枢椎脱位的TOI外科分型概念清楚,界定明确,可根据分型选择相应的寰枢椎脱位处理方式。
Objective：To explore a definitive clinical classification method of atlantoaxial dislocation and offer therapeutic regimen with strong guidance to the clinic practice.nethod：168 cases with C1-2 dislocation due to different causes were grouped into 3 types and 4 subtypes, （1）reduction by traction type,which was termed as the type T and was divided into T1 and T2 subtype based on different cause and course of disease.（2） reduction by operation type,which was termed as the type O;（3）Irreducible type,which was termed as type Ⅰ. We named this classification as TOI.Therapeutic protocoles were adopted as following,Type T1 ：applying traction or orthosis for 8-10 weeks,Type T2：reduced by traction followed by C1-2 fusion.Type O：Transoral anterior release followed by posterior fixation.Type Ⅰ：decompression and fixation in situ.According to Symon and Lavender clinical standard,JOA scoring and SAC imaging index were used to evaluate the therapeutic effect. Result：Among 168 cases,type T had 137 cases （81%）,type T1 had 71 cases （43%）,type T2 had 66 cases （38%）,type O had 28 cases（17%）,and type Ⅰ had 3 cases（2%）.The SAC was 3-13mm before operation,averaging 8mm,11-19mm after operation,averaging 16mm.The improving rate of neurological function was 64.7%.Clinical efficient plus excellence rate was 88.7%.Among the cases with type T,there were 77 cases undergoing no fusion of atlantoaxial joint still maintaing the C1-2 joint.Conclusion：TOI clinical classification of atlantoaxial dislocation is definitive,which can give a guidance in the treatment of different C1-2 dislocation.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2007年第2期111-115,共5页
Chinese Journal of Spine and Spinal Cord
关键词
寰枢椎
脱位
分型
Atlantoaxial
Dislocation
Classification
