颈枕融合术治疗颅颈交界区畸形伴寰枢椎不稳的疗效  

The effect of occipitocervical fusion for treatment of craniovertebral junction deformity with atlantoaxial instability

作　　者：张宇[1] 蔡艳娜[1] 张风江[1] 毛冲冲[1] 刘桠菲 刘献志[1] 

机构地区：[1]郑州大学第一附属医院神经外科,450052

出　　处：《中华神经外科杂志》2017年第2期142-146,共5页Chinese Journal of Neurosurgery

摘　　要：目的 探讨颈枕融合术治疗颅颈交界区畸形伴寰枢椎不稳的疗效.方法 回顾性分析2013年1月至2015年12月在郑州大学第一附属医院神经外科行颈枕融合术治疗颅颈交界区畸形伴寰枢椎不稳的患者35例.手术前后采用日本骨科协会（JOA）评分评估患者的疗效;采用寰齿间距（ADI）值评估寰枢椎水平脱位情况;测量齿状突与钱氏线的距离,评估垂直移位情况;测量延髓脊髓角（CMA）,评估脊髓受压情况.结果 术中未发生椎动脉出血、神经损伤等并发症.术后7d的JOA评分、ADI值、齿状突与钱氏线距离、CMA分别为（11.6±1.6）分、（2.8±0.6）mm、（3.1±1.5）mm、（152.7±6.2）°,与术前的（10.8±1.7）分、（8.2 ±2.9）mm、（8.1±5.5）mm、（130.1 ±10.3）°比较,差异均有统计学意义（均P ＜0.05）.术后1例（3％,1/35）患者因脑干大面积梗死死亡.术后3个月,1例（3％）因植骨融合失败行二次翻修手术,其余患者植骨及内固定均良好.术后随访6～30个月,平均（14.8±7.8）个月,32例症状缓解,2例未缓解,术后末次随访JOA评分为（13.2±1.7）分,与术前比较,差异有统计学意义（P＜0.05）.结论 颈枕融合术能有效治疗颅颈交界区畸形伴寰枢椎不稳.Objective To investigate the effect of occipital-cervical fusion on craniocervical junction deformity with atlantoaxial instability.Methods A total of 35 patients with craniocervical junction deformity with atlantoaxial instability were analyzed retrospectively,who underwent occipitocervical fusion at Department of Neurosurgery,the First Affiliated Hospital,Zhengzhou University from January 2013 to December 2015.The patients were followed up for 6-30 months.Before and after operations,the patients received evaluations based on the Japan Orthopedic Association （JOA） score.Atlantoaxial dislocation was assessed by means of the atlantoaxial distance （ADI）;the distance between the odontoid and Chamberlain＇s line（marked as H） was measured to evaluate the vertical displacement;and the cervicomedullary angle （CMA） was used to assess spinal cord compression.Results No complications including rupture of vertebral arteriesor nerve injuries occurred during the operations.At 7 days post surgery,the patients＇ mean scores of JOA,ADI,H and CMA were （11.6±1.6）,（2.8±0.6） mm,（3.1 ±1.5） mm and （152.7± 6.2） degrees,respectively.The preoperative corresponding values were （10.8 ± 1.7）,（8.2 ± 2.9） mm,（8.1 ±5.5） mm and （130.1 ± 10.3） degrees.The differences were all statistically significant （P 〈 0.05）.Postoperative findings demonstrated that 1 patient （3%） died of extensive brain stem infarction and 1 patient （3%） had undergone a revision operation due to fusion failure at the third month after surgery.The other patients reported good outcomes of bone grafting and internal fixation.The follow-up period was 6 ～ 30 months （mean,14.8 ± 7.8 months）.Thirty-two patients reported symptom relief and 2 patients had no remission.The JOA score was （13.2 ± 1.7） points at the last follow-up and statistically significant compared with the preoperative level（P 〈 0.05）.Conclusion The occipital-cervical fusion seems to be an effective treatment for the craniovert

关 键 词：寰枢关节 关节不稳定性 关节融合术 颅颈交界区畸形 

分 类 号：R651.1[医药卫生—外科学]