影像塑形及电生理监测在颅颈交界区畸形后路手术中的应用  

3D reconstruction model, intraoperative monitoring technology application to posterior restoration for the treatment in complex craniocervical junction deformity

作　　者：贾贵军[1] 吉宏明[1] 张燕[1] 张刚利[1] 姚晓辉[1] 胡昌辰[1] 任晋瑞[1] 

机构地区：[1]山西省人民医院神经外科,太原030012

出　　处：《中华神经外科杂志》2015年第2期188-191,共4页Chinese Journal of Neurosurgery

基　　金：山西省科学技术发展计划（20110313015-2）

摘　　要：目的 探讨影像塑形及电生理监测在复杂颅颈交界区畸形后路手术中的应用.方法 回顾性分析2006年5月至2013年5月采用颈枕后路减压复位内固定手术,结合影像、塑形技术及电生理监测治疗合并寰枢椎脱位的复杂颅颈交界区畸形21例患者的临床资料,手术前行影像评估、三维塑形模拟、日本骨科协会（JOA）评分.术中应用体感诱发电位及肌电图监测,并根据术后JOA评分和影像学改变评价疗效.结果 术后影像学显示：固定复位良好19例,复位不良2例;骨性融合良好21例.患者术后均不同程度临床好转,无围手术期死亡.随访时间6～34个月,JOA评分平均（11.67 ±3.16）分与术前（7.61±3.22）分比较,差异有统计学意义（t=-5.356,P＜0.01）.结论 颈枕后路减压复位内固定手术结合影像评估、塑形及电生理监测,提高了手术的安全性及精确度,临床效果满意.Objective To sum up the clinical experiences of the application of 3D reconstruction model and intraoperative monitoring in posterior restoration for the treatment of complex craniocervical junction deformity.Methods The clinical data of 21 patients with irreducible atlantoaxial dislocation were analyzed retrospectively,including imaging data,3D reconstruction model in craniocervical junction and Japanese Orthopedic Association （JOA） scores.The average JOA score was （7.61 ± 3.22） preoperatively.The posterior restoration and screw-rod （plate） internal fixation techniques were adopted in all the cases.Intraoperative monitoring techniques included SEP and EMG.The surgical outcomes were evaluated according to JOA scores and imaging examination.Results The postoperative imaging examination showed that fixed system and atlantoaxial restoration were performed well in 19 cases and badly in 2.The bony fusion was performed well in 16 cases and baby in 1.There was no death.The clinical symptoms were improved to different extents postoperatively.There was no severe complication.All the patients were followed-up for median period of 10.6 months,ranged from 6 to 34 months.The average JOA score was（11.67 ±3.16）,which was significantly improved （t =-5.356,P 〈0.01） compared with that before operation.Conclusions Posterior restoration and screw-rod （plate） internal fixation techniques combined with modem imaging evaluation,3D reconstruction model and intraoperafive monitoring techniques could be helpful for good clinical results in the treatnent of complex craniocervical junction deformity.

关 键 词：颅颈交界区 先天畸形 成像 三维 电生理监测 内固定 

分 类 号：R651.1[医药卫生—外科学]