前路或后路手术治疗颅底凹陷症伴寰枢椎脱位的影像学复位效果  

A radiological study between anterior and posterior surgery in patients with basilar invagination and atlantoaxial dislocation

作　　者：季伟[1] 鲍铭贵 许攀杰 杨进城 陈建庭[1] 张忠民[1] Ji Wei;Bao Minggui;Xu Panjie;Yang Jincheng;Chen Jianting;Zhang Zhongmin(Department of Spine Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Orthopaedics,the First Affiliated Hospital of Shantou University Medical College,Shantou 515041,China)

机构地区：[1]南方医科大学南方医院骨科-脊柱骨科,广州510515 [2]汕头大学医学院第一附属医院骨科,汕头515041

出　　处：《中华骨科杂志》2022年第23期1571-1578,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82172523);广东省自然科学基金(2022A1515010488)。

摘　　要：目的评估前路或后路手术治疗颅底凹陷症合并寰枢椎脱位的影像学复位效果。方法收集2009至2021年在南方医科大学南方医院接受单纯前路或后路手术治疗颅底凹陷合并寰枢椎脱位50例患者的资料,男16例、女34例;年龄(45.04±11.78)岁(范围18~65岁)。于侧位X线片、CT矢状面重建及MRI T2WI测量手术前后寰枢关节间隙高度、寰枢关节夹角、寰枢关节位移、Claus高度、寰齿前间距、椎管储备间隙、延髓脊髓角、C_(0)~C_(2) Cobb角和C_(2)~C_(7) Cobb角。前路与后路手术患者各参数比较采用独立样本t检验。结果前路手术组25例,男7例、女18例,年龄为(45.24±9.86)岁,随访时间为(6.48±3.14)个月(范围3~14.5个月);后路手术组25例,男9例、女16例,年龄为(44.72±14.06)岁,随访时间为(7.04±2.87)个月(范围3~16个月),两组患者性别、年龄和随访时间的差异均无统计学意义(P>0.05)。两组患者术后Claus高度、寰齿前间距、椎管储备间隙、延髓脊髓角较术前均明显改善,差异均有统计学意义(P<0.05),而组间差异均无统计学意义(P>0.05)。前路手术组寰枢关节间隙高度、寰枢关节夹角较术前增大,寰枢关节位移减小,但后路手术组仅寰枢关节间隙高度较术前增大,差异均有统计学意义(P<0.05)。前路手术组术后C_(0)~C_(2) Cobb角(36.54°±11.13°)较术前(16.08°±9.36°)增大,而C_(2)~C_(7) Cobb角(13.21°±10.23°)较术前(22.96°±11.07°)减小,差异均有统计学意义(P<0.05);后路手术组术后C_(0)~C_(2) Cobb角(18.50°±10.95°)与术前(18.37°±11.42°)无变化,C_(2)~C_(7) Cobb角(17.13°±14.89°)较术前(20.22°±16.64°)略减小,差异均无统计学意义(P>0.05)。两组末次随访时各参数与术后的差异均无统计学意义(P>0.05)。结论前路或后路手术均可改善颅底凹陷症合并寰枢椎脱位患者的脊髓压迫,前路手术行寰枢关节间隙的撑开复位更为充分,但上颈椎前凸角度过度增大将导致Objective To analyze the improvement of patients with basilar invagination and atlantoaxial dislocation that treated by anterior or posterior surgery.Methods 50 patients with basilar invagination and atlantoaxial dislocation that underwent simple anterior or posterior surgery from 2009 to 2021 were included.There were 34 females and 16 males with a mean age of 45.04 years(range,18-65 years).All patients underwent thin-slice CT scan of the neck.Preoperative and postoperative measurements of atlantoaxial joint distance,atlantoaxial joint angle,atlantoaxial joint displacement,Claus'Height,atlas-dens interval,space available for the cord,cervicomedullary angle,C_(0)-C_(2) angle,and C_(2)-C_(7) angle were measured.Then,the data were analyzed by independent sample t test.Results 25 patients(7 males,18 females)were included in the anterior surgery group,and 25 patients(9 males,16 females)were included in the posterior surgery group.The mean age of the two groups was 45.24±9.86 years and 44.72±14.06 years,respectively,showing no statistical difference.The mean last follow-up time of the anterior and posterior surgery group was 6.48±3.14 months and 7.04±2.87 months,respectively.The odontoid distance,atlas-dens interval,space available for the cord and cervicomedullary angle in 2 groups were significantly improved after surgery(P<0.05),while there were no significant differences in the above parameters between 2 groups(P>0.05).In the anterior surgery group,the distance and angle of atlantoaxial joint were increased,and the atlantoaxial joint displacement decreased significantly.While in the posterior surgery group,only the atlantoaxial joint space increased(P<0.05).The C_(0)-C_(2) angle was significantly increased and the C_(2)-C_(7) angle was significantly decreased in the anterior surgery group(P<0.05),but there was no significant difference in these parameters in the posterior surgery group(P>0.05).In addition,there was no significant difference in parameters between the two groups at the last follow-up compared wit

关 键 词：颅底 颈寰椎 枢椎 脱位 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]