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目的报告31例经口咽齿突切除治疗寰枢关节脱位合并高位截瘫的并发症处理及其预防.方法本组男20例,女11例;年龄8~57岁,平均24.5岁.主要表现为不同程度的四肢痉挛性瘫痪.其中腹侧型颅底凹陷症22例,外伤性陈旧性齿突骨折移位5例、脱位3例,类风湿性关节炎1例.MRI显示齿突后倒,颈髓、延髓受压且向背侧成角移位.手术取咽后壁正中直切口,显微镜下用高速磨钻磨除部分寰椎前弓及齿突.解除其对延髓、高颈髓的压迫,治疗高位截瘫.结果术后9例出现井发症,其中高位颈髓损伤1例,脑脊液漏2例,腭裂2例,齿突切除不全1例,寰枢椎不稳定3例.经治疗7例恢复良好,2例死亡.结论术前通过X线及MRI片详细了解局部骨结构和软组织异常情况,不断提高手术操作技术是预防并发症的关键.若已发生并发症,根据病情选择不同的手术和药物治疗,多数患者可获得满意疗效.“,”Objective To study the management of complications of transoral odontoidectomy inpatients with atlantoaxial subluxation. Methods Thirty-one patients with atlantodrial subluxation treatedwith transoral odontoidectomy were retrospectively analyzed. The ages of the patients ranged from & to 57years, with an average of 24. 5 years. The main clinical manifestations were spastic quadriplegia in variousdegrees. The causes of atlantoaxial subluxation included ventral basilar invagination in 22 patients, rheumatoidarthritis in 1, traumatic odontoid process fracture in 5 and subluxation in 3. MRI scan showed the retropositional odontoid process compressing on the medulla and high cervical spinal cord, which was angulated posteriorly. Transoral odontoidectomy was done in all patients to release the compression and restore the neuralfunetion. Results The complications occurred in 9 patients postoperatively, which consisted of high cervicalspinal cord injury in 1, cerebrospinal fluid fistula in 2, cleft palate in 2, incomplete odontoid process resectionin 1 and cranio-cervical junction instability in 3. Following treatment, 7 cases recovered and 2 patients died.Conclusion Careful analysis of the X - ray and MRI findings for a complete understanding of the anatomicalabnormalities and the improvement of the operation technique are the important points f6r the prevention ofpostoperative complications which in most of the cases can be treated with active medical and surgical measures.