经口咽前路松解后路枕颈融合内固定术治疗颅底凹陷症  

Tram-oral approach ventral decompression and posterior occipitocervical fusion internal f＇Lxation：a safe and effective treatment for basilar invagination

作　　者：龚会军[1] 王兵[2] 周厚俊[1] 严琪[1] 李经辉[1] 陈晔[1] 余化霖[1] 杨蓉[1] 李科琴[1] 

机构地区：[1]昆明医科大学第一附属医院微创神经外科,650031 [2]昆明医科大学第一附属医院骨科,650031

出　　处：《中华神经外科杂志》2014年第5期485-488,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨颅底凹陷症发病机制及其对手术方式选择的意义。方法2009年7月至2013年5月收治颅底凹陷症患者9例，均接受手术治疗，其中男5例，女4例；年龄19～51岁，平均37岁。测量Chambedain线值、McRae线值、Wackenheimclival线值、寰齿前间距（AID）、Klausheight指数及延脊髓角度。9例均为原发性颅底凹陷症，行经口咽寰枢椎松解复位＋后路枕骨大孔减压术＋枕颈植骨固定融合术；术后随访3个月～3年。结果除1例临床症状无改善外，其余8例症状明显改善，经MRI复查对比，所有病例后颅窝容积均有扩大，对延髓腹侧受压成角度的患者受压明显改善，脊髓空洞的患者空洞明显缩小。结论经口咽寰枢椎松解复位＋后路枕骨大孔减压术＋枕颈植骨固定融合术，手术效果明显，安全性高，值得推广。Objective To explore a classification system of basilar invagination based on pathogenesis and to investigate its clinical significance. Methods From July 2009 to May 2013, 9 patients with basilar invagination were treated at our department by surgery, 5 males and 4 females with a mean age of 37 years（ ranged 19-51 years） . There are three elements for diagnosis basilar invagination in Magnetic Resonance Imaging （MRI） ： the first, Boogard angle more than 145 ; the second, the top edge of odontoid higher than Chamberlain＇s line more than 5 mm; The third, the top of odontoid distance from the line between the tuberculum sellae and occipital protuberance less than 30 min~ In accordance with one of the above three elements can be regarded as basilar invagination. All of the 9 case were regarded as congenital basilar invagination and treated with Transoral approach ventral decompression and posterior occipitocervical fusion internal fixation. Postoperative follow-up is of 3 months to 3 years. Results Besides one case＇s symptoms were worse than those of this case before the operation. Another 8 cases＇ clinical symptoms showed an improvement which made these cases better than they were before the operation. It can be proved by MRI. Conclusions Transoral approach ventral decompression, posterior occipitocervical fusion and internal fixation for Basilar Invagination is safe and for basilar invagination.

关 键 词：颅底凹陷症 神经外科手术 减压术 外科 融合术 

分 类 号：R687.3[医药卫生—骨科学]