寰枢关节间撑开技术治疗颅底凹陷症的临床疗效分析  

Analysis of clinical effect of atlantoaxial distraction technique for the treatment of basilar invagination

作　　者：许俊杰[1] 蓝思彬 吴增晖[1] 夏虹[1] 马向阳[1] 艾福志[1] 章凯[1] 段明阳 杨善智 陈恩良 梁达轩 XU Junjie;LAN Sibin;WU Zenghui;XIA Hong;MA Xiangyang;AI Fuzhi;ZHANG Kai;DUAN Mingyang;YANG Shanzhi;CHEN Enliang;LIANG Daxuan(Department of Spinal Surgery, Orthopaedics Hospital,Guangzhou General Hospital of Guangzhou Military Command,Guangzhou, Guangdong 510010, China;Institute of Traumatic Orthopaedics of PLA, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, Guangzhou, Guangdong 510010, China)

机构地区：[1]广州军区广州总医院骨科医院脊柱外科,全军创伤骨科研究所全军热区创伤救治与组织修复重点实验室,510010

出　　处：《中国骨科临床与基础研究杂志》2017年第4期197-203,共7页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：广东省自然科学基金项目(2014A030313600);国家自然科学基金(81672178)

摘　　要：目的观察寰枢关节间撑开技术——经口寰枢椎复位钢板内固定(TARP)治疗颅底凹陷症伴难复性寰枢椎脱位的临床疗效,探讨TARP术后神经功能恢复的相关影响因素。方法回顾性分析2010年8月至2012年7月广州军区广州总医院采用TARP手术治疗的22例颅底凹陷症伴难复性寰枢椎脱位患者的临床资料。分别测量术前及末次随访时寰齿间隙(ADI)、Chamberlian线(CL,CT矢状位上硬腭到枕骨大孔的连线)和O-C_2角(Mc Gregor线与枢椎椎体下缘交角),计算齿突下移距离(dCL)和O-C_2角变化量(dO-C_2角);采用日本骨科学会(JOA)神经功能改善率评估患者神经功能恢复程度,根据神经功能改善率将患者分成A组(改善率<50%)和B组(改善率≥50%),其中A组5例,B组17例。结果TARP术后22例患者临床症状均获得不同程度改善。两组ADI、CL、dCL、O-C_2角、d O-C_2角等影像学参数比较,差异无统计学意义(P>0.05);A组、B组平均病程分别为(106±68)和(45±47)个月,A组明显长于B组(P<0.05)。1例患者术后脑干仍存在持续压迫,予二期经口齿突切除伴后路内固定翻修术,症状无显著缓解。随访期间未见内固定失败病例。结论寰枢关节间撑开技术治疗颅底凹陷症是有效的,不伴齿突切除的TARP技术能有效下移齿突并充分减压椎管;术后神经功能的恢复可能与病程相关。Objective To investigate the clinical outcomes of atlantoaxial distraction technique,namelytransoral atlantoaxial reduction and plate fixation(TARP)without odontoidectomy for the treatment of basilarinvagination(BI)with irreducible atlantoaxial dislocation(IAAD),and to explore the influence factors for neurological improvement after TARP surgery.Methods From August2010to July2012,22consecutive patientswith BI and IAAD were treated by TARP surgery in Guangzhou General Hospital of Guangzhou MilitaryCommand,and their clinical data were retrospectively analyzed.The pre-and post-operative atlas-dens interval(ADI),distance between the tip of the dens and Chamberlain's line(CL,the line extends from hard palatethrough foramina magnum in sagittal CT scan),the angle between McGregor's line and the inferior surface lineof the axis(O-C2angle)were measured,the odontoid process descent distance(dCL)and the difference in O-C2angle(dO-C2angle)were also calculated.Neurological function was evaluated as neurological improvement ofscores of Japanese Orthopaedic Association(JOA),and the patients were assigned to group A(recovered<50%)or group B(recovered>=50%)based on their level of neurological improvement,in which there was5patientsin group A and17patients in group B.Results All patients improved clinically to various degrees.There wereno significant differences in the radiographic parameters such as ADI,CL,dCL,O-C2angle,dO-C2angle in twogroups(P>0.05).The mean preoperative symptom treatment interval(STI)for group A was(106±68)months;for group B,it was(45±47)months(P<0.05).Persistent brainstem compression was observed in one patient.After a revision surgery of transoral odontoidectomy and posterior fixation,the patient's symptoms were notadequately relieved.No fixation failure was observed during the follow-up in all patients.ConclusionsAtlantoaxial distration technique is effective for treating BI,a TARP procedure without odontoidectomy may beable to pull the dens caudally and achieve sufficient decompression of the spinal cord

关 键 词：颅底凹陷症 寰枢关节 脱位 经口手术 齿突尖 减压术 外科 骨板 内固定器 

分 类 号：R687.3[医药卫生—骨科学]