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学科主题临床医学
Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation
Wang, C; Yan, M; Zhou, HT; Wang, SL; Dang, GT
关键词atlantoaxial dislocation reduction anterior release transoral surgery occipitocervical fusion
刊名SPINE
2006-05-15
31期:11页:E306-E313
收录类别SCI
文章类型Article
WOS标题词Science & Technology
类目[WOS]Clinical Neurology ; Orthopedics
研究领域[WOS]Neurosciences & Neurology ; Orthopedics
关键词[WOS]UPPER CERVICAL-SPINE ; CRANIOCERVICAL JUNCTION ; FUSION ; DECOMPRESSION ; COMPRESSION ; INSTABILITY ; SURGERY ; LESIONS
英文摘要

Study Design. A retrospective study of surgical outcome of 33 patients with irreducible atlantoaxial dislocation (IAAD).

Objective. To evaluate the safety efficacy of one stage anterior release and posterior fixation and fusion to reduce and stabilize IAAD.

Summary of Background Data. The traditional treatment of symptomatic IAAD is ventral decompression by transoral approach. This procedure is accompanied with high morbidity and mortality. It does not correct the swan neck deformity, which could precipitate the degenerative changes in the lower cervical spine. Our hypotheses were that it is the contraction of the muscles, ligaments, and capsules of atlantoaxial joint that prevent reduction, and that most of IAADs might be reduced by anterior atlantoaxial joint release without the odontoid resection, and that further reduction and stabilization might be achieved by special posterior fixation.

Methods. A consecutive series of 33 patients with IAAD were surgically treated. Dislocation or reduction was assessed before surgery, immediately after surgery, and at the final foI5786-up. Etiology, instrumentation, levels fused, and complications were documented. All patients were assessed clinically for neurologic recovery by Odom′s method.

Results. The mean age was 32 years (range, 7-63 years). The pathology included os odontoideum in 8 patients, occipitalization of C1 in 19 patients, malunion of odontoid fracture in 5, and relaxation of transverse ligament of atlas in 1. Twenty five patients presented neurologic signs and symptoms. Anterior release was performed without odontoid resection in all cases. Four patients underwent transarticular C1-C2 screw fixation, 3 had C1-C2 pedicle screw and plate fixation, and 26 required occipitocervical fixation. Twenty-five cases resulted in an anatomic reduction, 8 had partial reduction. Complication included one dysphagia and two nasal phonations. The mean follow-up period was 33.7 months ( range, 24 - 55 months). There was no pseudarthrosis, and all but 1 of the patients with neurologic deficit showed improvement.

Conclusion. This series has demonstrated the safety and efficacy of the transoral anterior atlantoaxial release in the reduction of IAAD. Most of the so-called irreducible/fixed AAD could become reducible after anterior release without odontoid resection. The posterior short-segment atlantoaxial or occipitocervical fixation, especially the plate screw instrumentation, could achieve further reduction and provide immediate stabilization. One-stage anterior release and posterior instrumentation and fusion are a safe and reliable operation in experienced hands.

语种英语
WOS记录号WOS:000237469400021
引用统计
被引频次:71[WOS]   [WOS记录]     [WOS相关记录]
文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/61997
专题北京大学第三临床医学院_骨科
作者单位Peking Univ, Hosp 3, Dept Orthopaed, Beijing 100083, Peoples R China
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GB/T 7714
Wang, C,Yan, M,Zhou, HT,et al. Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation[J]. SPINE,2006,31(11):E306-E313.
APA Wang, C,Yan, M,Zhou, HT,Wang, SL,&Dang, GT.(2006).Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation.SPINE,31(11),E306-E313.
MLA Wang, C,et al."Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation".SPINE 31.11(2006):E306-E313.
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