寰椎侧块-枢椎椎弓根钉棒技术在先天性颅颈交界区畸形翻修手术中的应用  

C1 lateral mass-C2 pedicle screw and rod instrument for revision surgery of congenital craniocervical junction malformation

作　　者：郭胜利[1] 张剑宁 程岗 孙君昭 乔广宇[1] GUO Sheng-li;ZHANG Jian-ning;CHENG Gang(Department of Neurosurgery,the Sixth Medical Center of PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院神经外科医学部,北京100853

出　　处：《临床神经外科杂志》2020年第4期366-370,共5页Journal of Clinical Neurosurgery

基　　金：国家重点研发计划项目(2018YFC1002500)。

摘　　要：目的探讨寰椎侧块-枢椎椎弓根螺钉棒复位内固定技术对于已行不当后颅窝减压术的先天性颅颈交界区畸形患者进行翻修手术的可行性及临床疗效。方法回顾性分析2013年1月—2016年1月中国人民解放军总医院第一医学中心神经外科收治的21例先天性颅颈交界区畸形患者的临床资料。其中18例患者在外院已行后颅窝减压术,3例患者行后颅窝减压术+枕颈内固定术。患者术前及术后均行颅颈交界区3D-CT及MRI检查,评估寰枢椎脱位和上颈髓受压的程度;采用日本骨科协会(JOA)评分标准对患者的临床状况进行评价。所有患者均采用后路寰椎侧块-枢椎椎弓根螺钉-棒技术行寰枢复位内固定,并取髂后上棘松质骨颗粒植骨融合。结果本组患者的翻修手术均成功实施,术中未出现脊髓、椎动脉损伤。术后20例患者完成了6~24个月,平均12.2个月的随访。3D-CT复查示,19例患者(90.5%)获得垂直方向的完全复位,18例患者(85.7%)获得水平方向的完全复位;植骨均出现融合,未出现钉棒脱落或复位丢失者。MRI复查显示,上颈髓受压均获得缓解。术后3个月的JOA评分从术前的(9.8±2.1)分提高到(14.1±1.9)分,差异有统计学意义(P<0.01)。结论寰椎侧块-枢椎椎弓根螺钉-棒复位内固定技术治疗已行不当后颅窝减压术的先天性颅颈交界区畸形是安全有效且可行的。Objective To evaluate the clinical efficacy and feasibility of revision surgery of C1 lateral mass-C2 pedicle screw and rod fixation for the treatment of congenital craniocervical junction malformation after inappropriate posterior fossa decompression.Methods The clinical data of 21 patients who had congenital craniocervical junction malformation presented at the First Medical Center of PLA General Hospital for revision surgery between January 2013 and January 2016 were analyzed retrospectively.Of 21 patients,18 underwent posterior fossa decompression while 3 had posterior fossa decompression plus occipitocervical fusion but failed at previous institution.Pre and postoperative three-dimensional computed tomographic(CT)scans were used to evaluate the degree of dislocation.Magnetic resonance imaging(MRI)was performed to assess the extent of atlantoaxial dislocation and the compression of upper cervical spinal cord.Japanese Orthopedic Association(JOA)score was used to evaluate the neurological status.The revision surgeries were conducted by posterior-only approach,using the C1 lateral mass screw-C2 pedicle screw and rod instrument and cancellous bone from crista iliaca was used for bone graft.Results The revision surgeries were all successfully performed without intraoperative injury of the spinal nerve,blood vessel or dura mater.Follow-up ranged from 6 to 24 months(mean 12.25 months)in 20 patients.Post-operative three-dimensional CT showed that complete horizontal reduction was obtained in 19/21(90.5%),and complete vertical reduction was obtained in 18/21(85.7%).The repeated three dimensional CT indicated that bony fusion was obtained in all patients.MRI demonstrated that compression of the medulla oblongata was relieved well.The mean postoperative JOA score improved from 9.8 to 14.1(t=18.650,P<0.01)3 months after revision surgery.Conclusion Posterior revision surgery using the C1 lateral mass screw-C2 pedicle screw and rod instrument which can achieve reduction and fixation in one stage is an effective and safe me

关 键 词：先天性颅颈交界区畸形 翻修手术 寰枢椎脱位 颅底凹陷 

分 类 号：R651.2[医药卫生—外科学]