先天畸形性寰枢椎脱位课件.ppt

术中复位技术 Reduction Technique Treatment Preoperative management Anesthetic considerations Anterior decompression Posterior stabilization techniques Preoperative management Clinotherapy Cervical collar 枕颈区先天性畸形患者发生颈区疼痛，过伸过曲照片提示寰枢关节不稳，均应立刻给予颈托保护。 Skull traction or cervical traction 颅骨牵引复位后均应继之以融合手术，以保护脊髓。因为韧带结构的陈旧性损伤不可能完整修复而重建寰枢间的稳定性。 Anesthetic considerations During intubation, any sudden movements of the neck, especially flexion, should be strictly avoided. cervical collar protected Initially the patient is anesthetised using a short acting anesthetic. recovery of the respiratory functions determines that no cord injury has occurred during these procedures. Anterior decompression If the deformity is irreducible, with or without basilar invagination, posterior fusion is preceded by ventral decompression. transpalatal, transpharyngeal route the anterior arch of the atlas and the lower portion of clivus, the odontoid and the C2 body---exposing the dura Transoccipitocervical posterolasteral approach Transoral approach Extent of excision齿状突的切除范围 An adequate vertical decompression during the transoral decompression is ensured by excising the part of C2 above the Wackenheims clival canal line projected into the cervical canal. Posterior stabilization techniques Atlantoaxial fusion Occipitocervical fusion Atlantoaxial fusion（C1-C2 fusion） Transarticular screw fixation C1 lateral mass fixation modified Brook’s type fusion autologous rib grafts (a) C2 pars interarticularis screw (b) C2 pedicle screw fixation (c) C2 Translaminar Screw Fixation Occipitocervical fusion（C1-C2 fusion or fusion extended C3-C4 ） Occipitocervical rib grafts Rod and wire (contoured loop) fixation Rod and screw fixation Lateral radiograph 山东万杰医学高等专科学校—诊断学精品课程 Congenital Atlanto-Axial Dislocation Anatomy Definition Biomechanics Embryology and development Manifestations Diagnosis and differential diagnosis Treatment Prognosis Anatomy Atlanto-Axial instability