摘要目的:比较显微镜下微创肌间隙寰枢侧块融合术（Mis-PALF）和开放寰枢融合固定术对寰枢椎脱位的临床疗效。方法:回顾性分析2015年9月至2021年9月在北京大学第三医院接受Mis-PALF手术治疗（17例）或开放寰枢融合固定术（88例，作为对照）的寰枢椎脱位患者的临床资料。Mis-PALF组男9例，女8例，年龄（45.8±19.8）岁；对照组男48例，女40例，年龄（50.0±13.9）岁。比较两组手术时间、围术期出血量、术后体温、术后疼痛视觉模拟评分（VAS）、术后追加止痛药物情况、术后住院时间、随访日本骨科协会（JOA）评分改善率以及并发症等指标。结果:Mis-PALF组围术期出血量较开放组减少［（111.8±35.9）ml比（362.9±18.6）ml， P<0.01］、住院时间较短［（3.06±0.63）d比（4.24±0.14）d， P<0.01］、追加止痛药物人数较少（3/17比56/88， P<0.01）。两组手术时间［（125±7）min比（113±8）min， P=0.525］、术后发热（11/17比37/88， P=0.086）、术后VAS>3分比例（1/17比13/88， P=0.357）、随访JOA改善率（66.9%±28.8%比74.2%±28.6%， P=0.409）及并发症发生率（1/17比3/88， P=1.000）等指标差异均无统计学意义。 结论:相比开放寰枢融合固定术，在寰枢椎脱位患者中，Mis-PALF能显著减少围术期出血量、缩短术后住院时间、减少止痛药物使用，同时不增加并发症的发生。

abstractsObjective:To compare the clinical effects of minimally invasive intermuscular atlantoaxial lateral mass fusion (Mis-PALF) and open atlantoaxial fusion in patients with atlantoaxial dislocation.Methods:The clinical data of patients with atlantoaxial dislocation who received Mis-PALF operation (17 cases) or open atlantoaxial fusion (88 cases, as control) in the Third Hospital of Peking University from September 2015 to September 2021 were analyzed retrospectively. In Mis-PALF group, there were 9 males and 8 females, aged (45.8±19.8) years; and there were 48 males and 40 females in the control group, aged (50.0±13.9) years. The operation time, perioperative blood loss, postoperative body temperature, postoperative pain [assessed with visual analogue scale (VAS)], postoperative additional analgesic drugs, postoperative hospitalization time, the improvement rate of Japanese Orthopedic Association (JOA) scores of spinal cord function in three-months follow-up and complications were compared between the two groups.Results:Mis-PALF group had less perioperative blood loss than control group [(111.8±35.9)ml vs (362.9±18.6)ml, P<0.01], shorter hospitalization time [(3.06±0.63) days vs (4.24±0.14) days, P<0.01] and fewer additional analgesic drugs (3/17 vs 56/88, P<0.01). There was no significant difference between the Mis-PALF and control group in operation time [(125±7)min vs (113±8)min, P=0.525], patients with fever(11/17 vs 37/88, P=0.086) or postoperative pain (1/17 vs 13/88, P=0.357), the improvement rate of JOA score (66.9%±28.8% vs 74.2%±28.6%, P=0.409) and complications rate (1/17 vs 3/88, P=1.000). Conclusion:Mis-PALF can significantly reduce the perioperative blood loss, shorten the postoperative hospitalization time and the additionally use of analgesic drugs without increasing complications.