Boogaard角在颅底凹陷复位手术决策中的临床意义  

Clinical significance of Boogaard angle in surgical decision of basilar invagination reduction

作　　者：彭立玮 王鹏[1] 左威[1] 程超 杨帆[2] 熊东[1] 毛紫龙 赵磊[1] 彭驰 张津安 张雷[1] 李维新[1] Peng Liwei;Wang Peng;Zuo Wei;Cheng Chao;Yang Fan;Xiong Dong;Mao Zilong;Zhao Lei;Peng Chi;Zhang Jin’an;Zhang Lei;Li Weixin(Department of Neurosurgery,Tangdu Hospital,Fourth Military Medical University,Xi’an 710038,China;Department of Plastic Surgery and Burns,Tangdu Hospital,Fourth Military Medical University,Xi’an 710038,China;Department of Health Statistics,Second Military Medical University,Shanghai 200433,China)

机构地区：[1]第四军医大学唐都医院神经外科,西安710038 [2]第四军医大学唐都医院烧伤整形科,西安710038 [3]第二军医大学军队卫生统计学教研室,上海200433

出　　处：《中华脑科疾病与康复杂志（电子版）》2021年第6期336-342,共7页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

摘　　要：目的探究术后Boogaard角与患者报告的日本矫形外科学会(PRO-JOA)评分改善率之间的定量关系以指导颅底凹陷复位手术。方法回顾性分析第四军医大学唐都医院神经外科自2015年8月至2020年8月收治的颅颈交界区畸形患者的临床资料,测量包括Boogaard角在内的23个颅颈交界区影像学矢状位参数,并记录PRO-JOA评分以评估临床结局。统计颅底凹陷患者的PRO-JOA改善率(ΔPRO-JOA)和术后影像学参数。结果研究共纳入94例颅底凹陷患者。Boogaard角与ΔPRO-JOA的较好结局相关。在未调整模型中,Boogaard角与ΔPRO-JOA呈正相关(OR=1.04,95%CI:1.00~1.08);微调整模型(调整年龄、性别)中,结果未发生明显变化(OR=1.04,95%CI:1.01~1.08)。非线性模型中,Boogaard角<160.8°时,Boogaard角与ΔPRO-JOA呈正相关(校正OR=1.22,95%CI:1.03~1.44)。结论Boogaard角矫正将影响颅底凹陷患者ΔPRO-JOA,可作为颅底凹陷复位手术是否联合后颅窝减压的定量参考。Objective To investigate the quantitative relationship between postoperative Boogaard angle and the improvement rate of patient-reported Japanese Orthopaedic Association(PRO-JOA)score to guide basilar invagination reduction surgery.Methods The patients diagnosed with craniocervical junction malformation in the Neurosurgery Department of Tangdu Hospital,Fourth Military Medical University from August 2015 to August 2020 were retrospectively analyzed.Twenty-three radiographic sagittal parameters of craniocervical junction including Boogaard angle were measured,and PRO-JOA score were recorded to assess clinical outcomes.PRO-JOA improvement rate(ΔPRO-JOA)and postoperative radiographic parameters including Boogaard angle in patients with basilar invagination were measured.Results A total of 94 patients with basilar invagination were included in the study.Boogaard angle was associated with better outcome inΔPRO-JOA.Boogaard angle was positively associated withΔPRO-JOA in the unadjusted model(OR=1.04,95%CI:1.00-1.08).In the micro adjustment model(adjusted for age and gender),the results did not change significantly(OR=1.04,95%CI:1.01-1.08).In the nonlinear model,there was a positive correlation withΔPRO-JOA with Boogaard angle<160.8°(correction OR=1.22,95%CI:1.03-1.44).Conclusion Boogaard angle correction will affectΔPRO-JOA in patients with basilar invagination and can be used as a quantitative reference for whether basilar invagination reduction surgery is combined with posterior fossa decompression.

关 键 词：Boogaard角 颅底凹陷 后颅窝减压 矢状位参数 

分 类 号：R651.1[医药卫生—外科学]