英文复杂寰枢椎脱位的诊治课件

CelebrationforthesecondWuHaninternationalorthopedicpeakforum RecognitionandTreatmentofComplexAtlantoaxialDislocation TheOrthopedicHospitalofGeneralHospitalofGuangzhouCommondQing shuiYin HongXia Zeng huiWu Xiang yangMa KaiZhang Jian huaWang Fu zhiAi Xiao hongMai LeiWan Theatlantoaxialdislocationthatcomplicatingwithothercomplexfactors andcannotbetreatedwithconventionalmethodwasdenominatedasComplexAtlantoaxialDislocation Preface Concept InformationandMethod 74cases 36male 38female withaverageageof34years 2to54years Complexcongenitalabnormality39casesOsteoporosis7casesThediameterofthepedicleofvertebralarchoftheatlantoaxialwastoosmall8casesRebuildingoftheredislactionaftertheoperationofatlantoaxial10cases Complextrauma3casesRefractorinessrotationfixation4casesTumor3cases Generalinformation TreatmentMethods Differentespecialtreatmentwasusedtotreatdifferentcomplexcondition TARP IIIsurgery TransoralanteriorapproachforthefixationofC2withtheantidromicpediclescrewDeepgrindingdecompressiontechnologywithTARP IIIsurgeryPosterioratlantoaxialscrewandstickfixationoflateralmassofC1 2andlaminaofaxialTransoralextendedmandibulectomyforTARPsurgeryTransoralextendedpalateforenlargingapproachforthesevereinvaginatedtoothofepistropheusPrecisepersonalsurgerywiththeguidanceofCAD RPtechnologyRevisionforTARPsurgeryThetherapeuticprincipleandpurposewerereduction decompressionandstabilizationstill InformationandMethod Results 68casesgotanatomyreduction 6casesgotclosetoanatomyreduction andallofthemgotsufficientdecompression Theimprovementrateofcanalisvertebralisdecompressionreachedat86 andtheimprovementrateofspinalcordfunctionreachedat77 8 Complications 3casesofintracranialinfectionbecauseofleakageofcerebrospinalfluid andtwoofthemwerehealingwellafterintrathecalinjectionforonemonth 1caseofdelayedinfection 6weeksaftersugery UntreateddeathduetoreturnhomeTherewasnoothercomplication InformationandMethod TypicalCases Diagnosis Postoperationofbasilarimpression posteriorapproach AtlantoaxialdislocationSymptoms paresis deglutitioimpedita buckingfordrinkwater cannottakefoodnormally takingnasogastricfeedingtubedaily Imageologyandcomplexfactor Bonescarroundingthedens andthedenscouldnotreductionnormally thebrainstemandspinalcordwerecompressed Case1HuangXX male 26years ID 399280 TypicalCase1 YQS Pre OpCT Pre OpMR StemCordAngle 128 128 TypicalCase1 Bonescarroundingthedens YQS TypicalCase1 Treatment TransoralatlantoaxialreductionandfixationSpecialTreatment Deeplygrindingthecallusthataroundthetoothofepistropheus withsufficientsolutionforTARP IIIsurgery Result atlantoaxialgotanatomyreduction reliefofcervicalspinalcordcompressionafterTARPinternalfixation Cornuaofspinalcordwasnormal andthefuncitonofthenervefunctionrecovergreatly andcouldwalkandswallownormally TypicalCase1 openmouth expose releaseanddecompress installTARP CarryoutTARPoperation release reduce decompressandfixatthesametime Post Op TARPIIIfixation C1 C2getreduction Typicalcase1 Pre op Post op 典型病例case2 thespinalcordwasdecompressionfully Diagnosis Malunionofthefractureofthedens Atlantoaxialdislocation Oldfractureofarticulatiomandibulariswithjointstiffness Symptoms couldnotopenmouth paresis Imageologyandcomplexfactor Thegastroofthecervicalspinalcordwascompressed Thearticulatiomandibulariswasstiffness difficultinopeningmouth Case2Zhang male 38year ID 344686 TypicalCase TransoralextendedmandibulectomyforTARPsurgery YQS YQS YQS TypicalCase2 X rayofpostoperationatA PPosition X rayofpostoperationatLP C2gottwocortexesfixation X rayofpreoperationatLP Atlantoaxialanatomyreduction YQS YQS YQS TypicalCase2 MRIofPostoperation MRIofPreoperation thespinalcordwasdecompressionfully YQS YQS TypicalCase2 Diagnosis Ruptureoftheligamentumtransversum AtlantoaxialdislocationSymptoms neckpain limitationofmotion Imageologyandcomplexfactor Thediameterofthepedicleofvertebralarchoftheatlantoaxialwastoosmall andthepatientwastooyoung Case3LiuX female 4years ID 387798 YQS TypicalCase Three dimensionalmodelofC2anddesignofScrewpath YQS YQS TypicalCase3 imitateplacingscrewinpedicleofC1 2preoperatively YQS YQS TypicalCase3 Drillingandplacingscrewfollowedbytheconductoftargetingtemplateintraoperatively YQS TypicalCase3 Post OpX ray ideallocationofthescrews TypicalCase3 Post OpCT thescrewpathwasnormal YQS TypicalCase3 Postoperativephotographofbaby TypicalCase3 Case4ZengX male 1 years ID 421125 CaseHistory wryneck2monthswithunsteadywalking5weeksDiagnosis tumorofthedens atlantoaxialdislocation OperationIntended AtlantoaxialPosteriorpediclescrewfixation TypicalCase4 CT deconstructionofthedens TypicalCase4 AmodelforatlasandaxialscrewinsertionwasdisignedthroughCAD RPtechnique TypicalCase4 TypicalCase4 Post OpX ray ideallocationofthescrews Post opCT pre opCT TypicalCase4 Post op Diagnosis BasilarinvaginationSymptoms neckpain numbnessanddebilitationoflimbsComplexFactors deeplyinternalizingofthedens Thegastroofthecervicalspinalcordwascompressed Syringomyelia Case5LiXX female 35years ID 417423 TypicalCase5 Pre OpMR TypicalCase5 StemCordAnglelessthannormalThegastroofthecervicalspinalcordwascompressedSyringomyelia Treatment TransoralatlantoaxialdecompressionandfixationSpecialTreatment TARP IIIsurgeryResult symptomsdisappearedafteroperation MRIshowedcompletedecompressionofcervicalspinalcord StemCordAnglebacktonormal andimprovementofSyringomyelia TypicalCase5 Post Op ReductionofthedensIdeallocationofTARP III TypicalCase5 Post OpMR StemCordAnglebacktonormalDecompressionofthespinalcordDisappearofSyringomyelia TypicalCase5 Pre OpMR Diagnosis failureApofixoperation redislocationoftheatlantoaxialvertebra Imageologyandcomplexfactor spinalcompressionfollowedbypostoperativeredislocationoftheatlantoaxialvertebrawithposteriorapproach Case6HuangX F 41years ID 364950 YQS TypicalCase6 Compressedspinalcordseriously YQS TypicalCase6 RemoveposteriorinternalfixationAnteriorTARPinternalfixationrevision preoperative Post Op anatomicalreduction YQS YQS YQS TypicalCase6 preoperative Completedecompressionofspinalcord Spinalcompressionwasrelievedafteratlantoaxialreduction butamyelotrophy YQS YQS TypicalCase6 Discussion Discussion AbnormityofthecraniocervicaljunctionBonescarroundingthedens bonyfusionofC1 2Basilarimpression thedensgreatlyinternalizedintotheintracalvarium operationthroughposteriorapproachwasdonebefore Malunionofthefractureofthedens Atlantoaxialdislocation oldfractureofarticulatiomandibulariswithjointstiffness osteoporosisThediameterofthepedicleofvertebralarchoftheatlantoaxialwastoosmallRedislocationoftheatlantoaxialvertebraafteroperationthroughanteriorandposteriorapproaches ComplexFactors Table2Complexfactorsofcomplexatlantoaxialdislocationandspecialtreatmentprotocol Discussion Criticaltechnique TARP IIIoperation C2retro pediclescrewfixation Deep partgrindinganddecompressingtechniqueCAD RPtechniqueEnlargingapproach mandibularorpalatecleaving Reduction longitudinalbrace KeyPoints1 TARP IIIfixation C2retro pediclescrewmethod Reduction Horizontalpushing KeyPoints1 TARP IIIfixation C2retro pediclescrewmethod TARPreductorwithuniqueeffect 动画 KeyPoints1 TARP IIIfixation C2retro pediclescrewmethod TARPIII C2retro pediclescrew KeyPoints1 TARPII C2vertebrascrew TARP IIIfixation C2retro pediclescrewmethod Polyaxialself lockingmechanism Polyaxialpilotdrill Innerrings threads ImportantcontributionofTARP III C2retro pediclescrewmethodwhichprovidesRigidFixation polyaxialself lockingmechanismmakestheproceduresimple Instantreduction decompressionandfixation indicationcasesofalmostnonrecoverabledislocationoftheatlantoaxialvertebraorfillingwithosteotylusaroundDenssignificanceDeep partgrindingtheDens thepostsuperiorborderandslopeofodontoidvertebra arrivingatdirectdecompression invasivedecompression CombiningwithTARP soastomakenonrecoverabledislocationoftheat