颅底凹陷症患者枕颈融合术后枕颈角的变化及临床意义  

Changes and clinical significance of occipito-C2 angle after occipitocervical fusion in patients with basilar invagination

作　　者：王联强 唐超 钟德君 马飞 王清 廖烨晖 唐强 WANG Lianqiang;TANG Chao;ZHONG Dejun(Department of Orthopedics,Affiliated Hospital of Southwest Medical University,Luzhou,646000.China)

机构地区：[1]西南医科大学附属医院骨科,四川省泸州市646000

出　　处：《中国脊柱脊髓杂志》2022年第1期2-9,共8页Chinese Journal of Spine and Spinal Cord

基　　金：四川省卫生健康委员会科研课题(编号:20PJ141)。

摘　　要：目的:观察颅底凹陷症(basilar invagination,BI)患者枕颈融合(occipito-cervical fusion,OCF)术后枕颈角(occipito-C2 angle,OC2A)的变化,分析术后OC2A变化值与OC2A术中矫正值的相关性以及对术后下颈椎的影响。方法:回顾性分析2013年9月~2019年4月我院收治的行OCF手术治疗的30例原发性BI患者的临床资料。其中男11例,女19例,年龄49.0±12.2岁(29~71岁)。固定节段:C0-C220例,C0-C38例,C0-C42例。在患者术前和术后7d、3个月、6个月、1年、2年时的标准颈椎侧位X线片上测量OC2A,在术后7d和术后2年时测量下颈椎椎间盘与椎体高度比(S值)、下颈椎前凸角(C2-C7角)、C4椎体中心至McGregor线垂直距离(the occiput-C4 distance,OC4D)、寰齿前间隙(atlas-dens interval,ADI)以及斜坡椎管角(clivus-canal angle,CCA)。计算术后7d与术前OC2A的差值,记为OC2A术中矫正值;计算术后2年与术后7d OC2A、S值、C2-C7角、OC4D、ADI、CCA的差值,分别记为OC2A术后丢失值、ΔS值、ΔC2-C7角、ΔOC4D、ΔADI、ΔCCA。Pearson相关分析法研究OC2A术后丢失值与OC2A术中矫正值、ΔS值、ΔC2-C7角、ΔOC4D、ΔADI、ΔCCA之间的相关性。结果:患者术前OC2A为5.4°±7.2°,术后7d、3个月、6个月、1年、2年OC2A分别为15.8°±5.6°、13.5°±4.5°、12.4°±4.7°、11.6°±4.6°、11.2°±5.1°,术后1年与2年随访OC2A值比较差异无统计学意义(P>0.05),其余各随访时间点OC2A两两比较差异均有统计学意义(P<0.05)。术后7d和2年的S值为0.469±0.034、0.436±0.042,C2-C7角为16.5°±8.4°、10.9°±6.7°,OC4D为6.14±0.63cm、5.31±0.55cm,ADI为2.37±0.85mm、3.18±0.92mm,CCA为141.4°±21.1°、132.6°±17.5°,术后2年均较术后7d减小,差异有统计学意义(P<0.05)。OC2A术中矫正值为10.4°±9.9°,OC2A术后丢失值、ΔS值、ΔC2-C7角、ΔOC4D、ΔADI、ΔCCA分别为4.6°±4.2°、-0.033±0.018、-5.6°±5.2°、-0.83±0.48cm、-0.81±0.67mm、-8.8°±18.4°。Pearson相关分析提示OC2A术后丢失值和术Objectives:To observe the changes of the occipito-C2 angle(OC2A)in basilar invagination(BI)patients after occipito-cervical fusion(OCF).The correlation between postoperative OC2A change value and intraoperative OC2A correction value and its influence on postoperative curvature of subaxial cervical was analyzed.Methods:The clinical data of 30 primary BI patients who underwent OCF surgery in our hospital from September 2013 to April 2019 were retrospectively analyzed.There were 11 males and 19 females,aged 49.0±12.2 years(29-71 years),including C0-C2 fixation in 20 cases,C0-C3 fixation in 8 cases,and C0-C4 fixation in 2 cases.The OC2A of BI patients were measured on standard lateral cervical X-rays before operation and 7 days,3 months,6 months,1 year and 2 years postoperatively.Meanwhile,the heightratio of subaxial cervical disc to vertebral body(S value),the subaxial cervical angle(C2-C7 angle),the occipto-C4 distance(OC4D),atlas-dens interval(ADI)and clivus-canal angle(CCA)were measured at 7 days and 2 years after surgery.The difference of OC2A between 7 days postoperatively and pre-operation was calculated and recorded as OC2A interoperative corrected value,and the differences of OC2A,S value,C2-C7 angle,OC4D,ADI,CCA of patients between 7 days and 2 years after operation were denoted as CO2A postoperative loss value,ΔS value,ΔC2-C7 angle,ΔOC4D,ΔADI,ΔCCA,respectively.Results:The preoperative OC2A of 30 patients was 5.4°±7.2°and the OC2A values 7 days,3 months,6 months,1 year,2 years postoperatively were 15.8°±5.6°,13.5°±4.5°,12.4°±4.7°,11.6°±4.6°,and 11.2°±5.1°respectively.There was no statistical difference in OC2A between 1 year and 2 years after operation(P>0.05)while the differences of OC2A between other follow-up time points were statistically significant(P<0.05).The S-values of 7 days and 2 years after operation were 0.469±0.034,0.436±0.042,C2-C7 angle was 16.5°±8.4°,10.9°±6.7°,OC4D was 6.14±0.63cm,5.31±0.55cm,ADI was 2.37±0.85mm,3.18±0.92mm,CCA was 141.4°±21.1°,132.6�

关 键 词：颅底凹陷症 枕颈融合术 枕颈角 下颈椎曲度 

分 类 号：R687.3[医药卫生—骨科学] R681.5[医药卫生—外科学]