先天性颅底凹陷症的临床分型及手术治疗体会（附103例报告）  

Classification and surgical treatment strategy of basilar invagination （ report of 103 cases ）

作　　者：范涛[1] 侯哲[1] 赵新岗[1] 赵思聪[1] 邱军[1] 梁聪[1] 

机构地区：[1]首都医科大学附属第十一临床医学院、北京三博脑科医院,100093

出　　处：《中华神经外科杂志》2014年第7期658-662,共5页Chinese Journal of Neurosurgery

摘　　要：目的 探讨先天性颅底凹陷症的临床分型、手术方法和疗效.方法 回顾性分析经手术治疗的103例颅底凹陷症.在Goel分类的基础上,将先天性颅底凹陷症进一步分为四型.根据不同类型颅底凹陷症的影像及临床特点,选择个体化的手术方法,并对其影像学及临床特点和手术方法的优劣进行综合评估.结果 103例患者中,101例术后疗效满意,JOA评分由术前（9.54±3.43）分提高至（12.76 ±2.53）分（t=4.732,P=0.036）;54例合并寰齿间距增大的患者均获得部分或完全复位;71例合并脊髓空洞的患者中,49例明显缩小（＞50％）,21例缩小,1例无变化.随访到81例患者,随访时间12 ～ 72个月.JOA评分由术前的（9.20±2.47）分提高至（13.82±2.37）分（t=4.823,P=0.028）.结论 根据寰枢脱位或脊髓空洞的有无,将先天性颅底凹陷症细分成四型,可准确反映复杂先天性颅底凹陷症的病理特征.通过临床表现结合影像学特征进行综合评估,选择个体化手术方案,可提高先天性颅底凹陷症的诊断和疗效.Objective To investigate the classification,personalized operative plan and therapeutic evaluation of basilar invagination.Methods The clinical data of 103 patients who accepted microsurgical treatment in our hospital were retrospectively analyzed.Based on Atul Goel classification,the basilar invagination were diagnosed and divided into four categories.The selected personalized operative plans,imaging features,clinical characteristics and surgical methods were evaluated.Results 101 of 103 cases achieved good outcomes.The main Japanese Orthopaedic Association （JOA）scale was increased from 9.54 ±3.43 to 12.76 ±2.53（t =4.732,P =0.036） after the procedures.A complete reduction or partial reduction was achieved in all patients who had increased atlantodental interval.In 71 patients with syringomyelia,the syringomyelia was obviously shrinked in 49 cases （〉 50%）,shrinked in 21,and unchanged in 1.81 cases were followed-up from 12 to 72 months.The JOA scale was improved from 9.20±2.47 to 13.82 ±2.37（t =4.823,P =0.028）after follow-up.Conclusions According to the existence of syringomyelia and（or） atlantoaxial dislocation,all the basilar invagination could be divided into four types,which chould accurately reflect the pathological features of complicated basilar invagination.Through the comprehensive assessment of clinical manifestation and imaging features,a personalized surgical procedure could be selected to improve the effects of treatment of congenital basilar invagination.

关 键 词：颅底凹陷症 临床分型 显微外科手术 治疗效果 

分 类 号：R651.1[医药卫生—外科学]