摘要
寰枢椎脱位(atlantoaxial dislocation,AAD)曾被在国际骨科界被视为“手术禁区”,死亡率极高。随着现代外科基础研究和诊疗技术的进步,其外科临床疗效也越来越好。然而,颅底和上颈椎的各种解剖变异和畸形,如颅底凹陷合并AAD、先天性寰枢椎椎弓根狭窄和高位异常椎动脉,增加了手术的难度和风险;再如严重AAD压迫所致延髓和上颈髓损伤的治疗,仍然是AAD对现代医学治疗的挑战。针对这一临床难题,个性化应用多种稳定性重建技术是有效的解决方案;寰枢椎脱位并发多发伤和内科疾病是寰枢椎脱位围手术期处理的主要问题;多学科团队模式也是解决这一问题的有效途径。“从督论治”脊柱疾病的学术观点和“脊髓减压疏通督脉”的治疗理念,也为探讨解决脊髓损伤神经功能康复临床难题提供了新的思路。
Atlantoaxial dislocation(AAD)has been internationally regarded as the"surgical exclusion zone",with a very high mortality.With the progress of modern surgical basic research and diagnosis and treatment technology,its clinical outcome is getting better and better.However,various anatomical variations and malformations of the skull base and upper cervical vertebrae,such as basilar invagination combined with AAD,congenital atlantoaxial pedicle stenosis and high abnormal vertebral artery,increase the difficulty and risk of surgery.Another example is the clinical problem of medulla oblongata and upper cervical spinal cord injury caused by severe AAD compression,which is still a challenge to modern medical treatment.To solve this clinical problem,individualized application of multiple stability reconstruction techniques is an effective solution.Multiple injuries and medical diseases are the main problems in the perioperative management of atlantoaxial dislocation,while multidisciplinary team model is also an effective way to solve this problem.The academic viewpoint of"treating spinal diseases from the perspective of governor"and the treatment principle of"dredging the governor arteries by decompression of the spinal cord"also provide new ideas for exploring and solving the clinical difficulties of neurological function rehabilitation in spinal cord injury.
作者
谭明生
TAN Ming-sheng(Department of Spinal Surgery,China-Japan Friendship Hospital,Beijing 100029,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2022年第21期1921-1924,共4页
Orthopedic Journal of China
关键词
寰枢椎脱位
手术治疗
椎弓钉固定
中医
西医
atlantoaxial dislocation
surgical treatment
pedicle screw fixation
traditional Chinese medicine
Western medicine
