中文摘要：

[目的]分析评估寰枢椎脱位前后路联合手术经口咽前路松解过程中,利用撬拨侧块测试后伸柔韧性确定寰枢关节松解程度的有效性和安全性。[方法]自2009年1月-2014年6月,回顾性分析采用经口咽前路松解、后路复位减压、寰枢椎或枕颈固定融合术治疗的寰枢椎脱位患者23例,男14例,女9例;年龄18-65岁,平均39.9岁。经口咽前路松解过程中,均按解剖层次逐步切除瘢痕、关节囊、韧带或植骨块等阻碍复位的组织,使寰枢侧块关节间隙在撬拨下获得3-5 mm的松动后,后路一期复位、固定、融合。术后根据X线片、CT评估复位及融合状态,JOA评分评估神经功能恢复情况。[结果]所有患者均顺利完成手术,手术时间180-350 min,平均260min;失血量400-1 100 ml,平均700 ml。术中未发生椎动脉、神经和脊髓等损伤,术后无咽壁及椎管内感染发生。19例（82.6%）获得完全复位,4例（17.4%）不完全复位。脑干脊髓角恢复至平均143.5°,其中21例达到正常,2例小于正常。平均随访时间18个月（6-45个月）,随访期间未见内固定松动表现,植骨均获得骨性融合;临床症状有所改善,JOA评分从术前平均7.8分提高到术后平均12.9分（P〈0.05）。[结论]在经口咽前路松解过程中,侧块撬拨测试后伸柔韧性提供了简便可行的松解程度测试方式,活动度达到3-5 mm视为松解充分,成为前后路联合手术治疗严重寰枢椎脱位手术操作中的辅助技术。

英文摘要：

[Objective]A new technique of leverage test of extension flexibility was introduced and investigated in order to confirm the release of atlantoaxial facet joints during anterior transoral release.[Method]From January 2009 to June 2014,23cases（ 14 males and 9 females） with the mean age at operation of 39.9 years（ range,18-65） underwent anteriortransoral release combined with posterior decompression,reduction and fusion（ atlantoaxial fusion / occiputocevical fusion）.During anterior transoral release,contracture muscles,ligaments,joint capsules,even scar tissues and bone graft engaged in revision surgery were dissected by anatomic layers.After 3-5 mm range of motion of bilateral facet joints of C1 /2 was achieved by levering the lateral mass,posterior reduction and instrumented fusion was performed subsequently.X-ray,CT and MRI scan were used to confirm reduction and fusion,JOA score was used to evaluate the improvement of neurofunction.[Result]Surgeries were performed successfully.The operation time was 180-350 min with average 260 min,the estimated blood loss was 400-1 100 ml with average700 ml.No injury of vertebral artery and spinal cord was found intraoperatively.No pharynx wall infection or intraspinal cord infection was found postoperatively.Ninteen cases（ 82.6%） achieved complete reduction while the other 4 cases（ 17.4%） achieved partial reduction.The cevicomedullary angle increased to average 143.5° postoperatively,21 cases reaching to normal and 2 cases below normal.All cases were followed up for 6 - 45 months（ mean 18 months）.During follow-up,no loosening of instruments was found,and bone fusion was detected.JOA score increased from 7.8 preoperatively to 12.9 postoperatively in average（ P〈0.05）.[Conclusion]During anterior transoral release,lever test of extension flexibility provides a convenient way to verify good release effect for successful posterior reduction when 3-5 mm range of motion has been achieved,which can be anassistant technique in one-stage anterior release a