前后路联合手术治疗颅底陷入症合并小脑扁桃体下疝畸形  

Combined anterioposteriorly approach to the basilar invagination complicated with the Chiari malformation

作　　者：胡建中[1] 张俊[1] 王君宇[1] 王锡阳[1] 林涨源[1] 邓展生[1] 龙文荣[1] 张宏其[1] 李康华[1] 

机构地区：[1]中南大学湘雅医院骨科,湖南省长沙市410008

出　　处：《中国脊柱脊髓杂志》2006年第6期417-420,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨颅底陷入症合并小脑扁桃体下疝畸形的手术治疗方法及效果。方法:8例颅底陷入症合并小脑扁桃体下疝畸形患者,术前均有不同程度四肢痉挛性瘫痪及感觉障碍,均行CT、MRI检查并测量有关数值:Klaus高度指数、齿状突尖到脑桥延髓交界处的距离及小脑扁桃体下疝深度。所有患者均首先接受后路减压、枕颈钛板固定、植骨融合,然后再经口咽行齿状突磨除术。结果:术后症状均得到缓解,随访8个月至2年,平均1.5年,术后半年8例患者生活均能自理,术后1年,4例患者能参与一般的体育活动,另4例患者也能进行较轻的劳动。MRI示内固定稳固,延颈髓角度明显增大,脊髓压迫解除,植骨融合。结论:对颅底陷入症合并小脑扁桃体下疝畸形的患者先行后路减压固定、植骨融合,再行前路经口咽入路磨除齿状突的联合手术,安全可靠、效果好。Objective：To investigate the surgical treatment of basilar invagination complicated with the Chiari malformation.Method：8 cases with basilar invagination complicated with Chiari malformation were reviewed.The principal clinical characteristics and the radiological index including the Klaus high index,odontoid tip-PM （pontomedullary junction）,the depth of cerebellar tonsil herniation of all 8 cases were analysed.All cases underwent posterior fossa decompression and occipito-cervical fusion followed by odontoidectomy via oral approach.Result：8 cases with partial quardroplegia preoperatively recovered to some extent postoperatively after a mean follow-up of 1.5 years（8 months to 24 months）,all patients were able to undertake the daily labour,all cases had the MRI evedences of bone fusion,enlarged CM angle and complete decompression.Conclusion：For patients with basilar invagination（BI） complicated with the Chiari malformation,the posterior fossa decompression and occipito-cervical fusion followed by odontoidectomy via oral approach is safe and reliable.

关 键 词：颅底陷入症 小脑扁桃体下疝畸形 后路减压 固定术 经口咽手术 

分 类 号：R682.1[医药卫生—骨科学] R687.3[医药卫生—外科学]