摘要： 目的  探讨应用寰椎侧块螺钉、枢椎椎弓峡部螺钉棒内固定术治疗颅底凹陷合并寰枢椎脱位的可行性及临床疗效。方法  回顾分析76 例颅底凹陷合并寰枢椎关节脱位患者临床诊断与治疗经过，其中合并寰椎枕骨化畸形的寰枢椎脱位50 例，未合并寰椎枕骨化畸形的寰枢椎失稳和脱位26 例（齿状突不连性或发育不良性寰枢椎脱位14 例、未合并脱位的颅底凹陷经前路切除齿状突减压所致医源性寰枢椎不稳12 例）。全部病例均采用寰椎侧块螺钉和枢椎椎弓峡部螺钉棒或下关节突螺钉棒系统进行复位固定，髂后上嵴松质骨颗粒植骨。结果  74 例获得满意临床治疗效果，出院时日本骨科协会（JOA）评分（17 分法）由术前的9.43 ± 3.16 提高至13.80 ± 2.07（t = 4.063，P = 0.037），Odom 评级优19 例、良49 例、可7 例、差1 例。未合并寰枕融合者经后路固定手术均获得解剖学复位；50 例伴寰枕融合患者中15 例完全复位、35 例部分复位；其中26 例经口腔入路施行减压。共50 例获3 个月以上随访，JOA 评分由术前的8.90 ± 1.22 提高至14.72 ± 1.57（t = 4.914，P = 0.015），Odom 评级优18 例、良30 例、可2 例、差0 例。随访期间未出现断钉、断板现象，内固定稳固、植骨完全融合。1 例术后清醒拔管12 h 突发呼吸、心跳停止，复苏成功后深度昏迷，家属放弃治疗出院；1 例术后第6 天发生全身凝血机制障碍，随后出现四肢完全瘫痪，目前仍然在康复治疗中，肌力恢复至3 级；2 例术后发生呼吸衰竭；2 例出现切口延迟愈合。无一例发生感染和后组脑神经损伤并发症。结论  应用Goel 内固定技术行寰枢椎关节复位、固定及植骨融合治疗畸形寰枢椎脱位安全可行，疗效满意。

关键词: 内固定术（非MeSH 词）, 扁颅底, 脱位, 寰枢关节, Goel技术（非MeSH 词）

Abstract: Objective To explore the surgical feasibility and clinical outcome of translateral mass and pars screws fixation (Goel's technique) in the treatment of atlantoaxial instability and dislocation. Methods Seventy-six patients were diagnosed as atlantoaxial dislocation, including 50 cases combined with occipitalization, and 26 patients with os odontoideum. Fifty-seven patients presented signs and symptoms of myelopathy or spinal cord injury. All of the patients underwent posterior operation of open reduction and arthrodesis with C1, 2 joint fixation with rods and screws in the lateral masses and pars articulars of the atlas and axis. Results Seventy-four cases obtained good outcome. The main Japanese Orthopaedic Association (JOA) scale increased from 9.43 ± 3.16 preoperation to 13.80 ± 2.07 postoperation (t = 4.063, P = 0.037). According to Odom's scoring system, 19 patients were assessed as excellent, 49 good, 7 fair and 1 poor. A complete reduction was achieved in 15 cases, 35 patients obtained partial reduction. Twenty-six patients underwent transoral anterior decompression. One patient occurred respiratory and cardiac arrest at 12 h after operation. One patient subjected disturbances of blood coagulation tetraplegia and recovered muscle power gradually recovered to grade 3. Fifty patients were followed up more than 3 months, all of them achieved articular fixation. JOA scale improved from 8.90 ± 1.22 before operation to 14.72 ± 1.57 (t = 4.914, P = 0.015) at the follow up period. In Odom's rank: assessment 18 patients were excellent, 30 good, 2 fair and 0 poor. Conclusion Posterior reduction and arthrodesis with rigid internal fixators by Goel's technique could achieve satisfactory outcomes in patients with atlantoaxial dislocation.

Key words: Internal fixation (not in MeSH), Platybasia, Dislocations, Atlanto-axial joint, Goel's technique (not in MeSH)