經后路超聲骨刀雙側切除齒狀突治療顱底凹陷癥合并不可復性寰樞關節脫位一例_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

胡博文 , 周春光 , 楊曦 , 劉立岷 ,  宋躍明

四川大學華西醫院骨科（成都 610041）;

Corresponding?author：

宋躍明, Email: sym_cd@163.com

Keywords：

寰樞椎脫位; 顱底凹陷癥; 齒狀突切除; 超聲骨刀

DOI：

10.7507/1002-1892.201711133

Video：

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目的總結采用 1 例經后路超聲骨刀雙側切除齒狀突治療的顱底凹陷癥合并不可復性寰樞關節脫位患者臨床資料。方法 2017 年 10 月 25 日，采用經后路超聲骨刀雙側切除齒狀突治療 1 例顱底凹陷癥合并不可復性寰樞關節脫位 40 歲女性患者。患者因“四肢麻木 2 年，加重伴四肢感覺、運動障礙 6 個月”入院，查體見 C₂ 平面以下感覺減退，右側上下肢肌力 1～2 級，結合影像學檢查提示顱底凹陷癥合并寰樞關節脫位，寰樞椎自發融合。結果術后患者右側肢體麻木乏力明顯緩解，肌力較術前改善；術后 CT 示齒狀突完整切除，MRI 示脊髓受壓解除。結論采用經后路超聲骨刀雙側切除齒狀突可行，可作為顱底凹陷癥合并不可復性寰樞關節脫位的治療方法之一。

Citation： 胡博文, 周春光, 楊曦, 劉立岷, 宋躍明. 經后路超聲骨刀雙側切除齒狀突治療顱底凹陷癥合并不可復性寰樞關節脫位一例. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(12): 1523-1525. doi: 10.7507/1002-1892.201711133 Copy

1.	Goel A. Progressive basilar invagination after transoral odontoidectomy: treatment by atlantoaxial facet distraction and craniovertebral realignment. Spine (Phila Pa 1976), 2005, 30(18): E551-555.
2.	Peng X, Chen L, Wan Y, et al. Treatment of primary basilar invagination by cervical traction and posterior instrumented reduction together with occipitocervical fusion. Spine (Phila Pa 1976), 2011, 36(19): 1528-1531.
3.	Zenga F, Pacca P, Tardivo V, et al. Endoscopic Endonasal Approach to the Odontoid Pathologies. World Neurosurg, 2016, 89: 394-403.
4.	Shousha M, Mosafer A, Boehm H. Infection rate after transoral approach for the upper cervical spine. Spine (Phila Pa 1976), 2014, 39(19): 1578-1583.
5.	Xia H, Yin Q, Ai F, et al. Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy. Eur Spine J, 2014, 23(8): 1648-1655.
6.	宋躍明, 黃思慶, 龔全, 等. 經枕頸后外側入路行畸形齒突切除術. 中華骨科雜志, 1999, 19(10): 581-584.
7.	Limin L, Chunguang Z, Yueming S, et al. A posterolateral approach to occipitoatlantoaxial ventral lesions: a report of the long-term follow-up of 23 cases. J Spinal Disord Tech, 2013, 26(5): 281-290.
8.	Chang HS, Joko M, Song JS, et al. Ultrasonic bone curettage for optic canal unroofing and anterior clinoidectomy. Technical note. J Neurosurg, 2006, 104(4): 621-624.

1. Goel A. Progressive basilar invagination after transoral odontoidectomy: treatment by atlantoaxial facet distraction and craniovertebral realignment. Spine (Phila Pa 1976), 2005, 30(18): E551-555.
2. Peng X, Chen L, Wan Y, et al. Treatment of primary basilar invagination by cervical traction and posterior instrumented reduction together with occipitocervical fusion. Spine (Phila Pa 1976), 2011, 36(19): 1528-1531.
3. Zenga F, Pacca P, Tardivo V, et al. Endoscopic Endonasal Approach to the Odontoid Pathologies. World Neurosurg, 2016, 89: 394-403.
4. Shousha M, Mosafer A, Boehm H. Infection rate after transoral approach for the upper cervical spine. Spine (Phila Pa 1976), 2014, 39(19): 1578-1583.
5. Xia H, Yin Q, Ai F, et al. Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy. Eur Spine J, 2014, 23(8): 1648-1655.
6. 宋躍明, 黃思慶, 龔全, 等. 經枕頸后外側入路行畸形齒突切除術. 中華骨科雜志, 1999, 19(10): 581-584.
7. Limin L, Chunguang Z, Yueming S, et al. A posterolateral approach to occipitoatlantoaxial ventral lesions: a report of the long-term follow-up of 23 cases. J Spinal Disord Tech, 2013, 26(5): 281-290.
8. Chang HS, Joko M, Song JS, et al. Ultrasonic bone curettage for optic canal unroofing and anterior clinoidectomy. Technical note. J Neurosurg, 2006, 104(4): 621-624.

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Chinese Journal of Reparative and Reconstructive Surgery

經后路超聲骨刀雙側切除齒狀突治療顱底凹陷癥合并不可復性寰樞關節脫位一例

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