术中即时牵引与后路复位枕颈固定治疗原发性颅底凹陷症  

Intraoperative traction combined with posterior occipitocervical reduction and fixation for primary basilar invagination

作　　者：黄伦海 涂洪波[2] 刘鹏[2] 赵建华[2] 

机构地区：[1]余庆县中医院外科,贵州余庆564400 [2]第三军医大学大坪医院野战外科研究所脊柱外科,重庆400042

出　　处：《局解手术学杂志》2011年第6期618-620,共3页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的评价术中即时牵引与后路钉-棒系统枕颈固定治疗颅底凹陷症的疗效。方法 2009年7月至2010年6月共收治5例颅底凹陷症患者,男1例,女4例,平均年龄45.2岁。患者均有明显神经功能损害症状J,OA评分平均10.6分。寰齿前距平均7.86 mm。齿突尖超McGregor线(腭枕线)平均15.12 mm。1例合并难复性寰枢关节脱位。全麻后头高脚低位均行(体重的1/6重量)颅骨牵引维持15 min。4例寰齿前距减小(小于4 mm),1例无明显复位征象患者即行前路经口腔松解后寰齿前距减小至2.7 mm。轴性翻身后经后路钉-棒系统枕颈固定。术后均给予费城颈托固定3个月。结果齿状突均有较好的复位,术后寰齿前距平均3.44 mm,齿突尖超McGregor线平均6.4 mm。无术中、术后并发症。平均随访8个月,均固定满意并坚固融合,末次随访时所有患者神经功能均有较好恢复J,OA评分平均15.8分,改善率为81.25%。结论术中即时牵引与后路钉-棒系统枕颈固定是治疗原发性颅底凹陷症安全、有效的方法。Objective To evaluate the clinical efficacy of intraoperative traction combined with posterior occipitocervical reduction and fixation using screw-rod system in treatment of basilar invagination.Methods Totally five patients with primary basilar invagination were admitted to our department form July 2009 to June 2010,including four females and one male with an average age of 45.2 years old.All the five patients had obvious symptoms of neurological functional damage,the average Japanese orthopaedic association score（JOA score） was 10.6 points.The average atlantoodontoid interval was 7.86 mm and the odontoid tip went 15.12 mm beyond the McGregor line（chamberlain line）.One case was complicated with irreducible atlantoaxial dislocation.Under general anesthesia,all patients were accepted skull traction for 15 minutes.The atlantoodontoid distances of four patients were diminished（〈4 mm）.One patient with no obvious signs of reduction was accepted the release by oral approach and the atlantoodontoid distance was diminished to 2.7 mm.All of them were received posterior occipitocervical reduction and fixation using screw-rod system after axial turning.All patients were received philadelphia neck collar as external fixation for three months postoperatively.Results All the patients achieved good reduction,the average atlantoodontoid distance was 3.44 mm and the odontoid tip went 6.4 mm beyond the McGregor line after operation.There was no complication intra and post operation.The follow-up averaged 8 months;all had good fixation and strong fusion.In the last follow-up,all patients had good neurological functional recovery,the average JOA score was 15.8 points,the improvement rate was 81.25%.Conclusion Intraoperative traction combined with posterior occipitocervical reduction and fixation using screw-rod system is a simple,safe and effective for basilar invagination.

关 键 词：术中牵引 颅底凹陷症 复位 枕颈融合 

分 类 号：R682.11[医药卫生—骨科学]