单纯后路手术治疗先天性颅底凹陷伴寰枢椎脱位的疗效分析  

Efficacy analysis of direct posterior reduction for the treatment of congenital basilar invagination complicated with atlantoaxial dislocation

作　　者：刘将 曾明慧 贾力 凌士营 计颖 魏祥品 牛朝诗 Liu Jiang;Zeng Minghui;Jia Li;Ling Shiying;Ji Ying;Wei Xiangpin;Niu Chaoshi(Department of Neurosurgery,the First Affiliated Hospital(Anhui Provincial Hospital),University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)神经外科,合肥230001

出　　处：《中华神经外科杂志》2023年第3期232-237,共6页Chinese Journal of Neurosurgery

摘　　要：目的探讨经单纯后路手术治疗先天性颅底凹陷伴寰枢椎脱位的安全性和有效性。方法回顾性分析2018年1月至2021年8月中国科学技术大学附属第一医院(安徽省立医院)神经外科收治的31例先天性颅底凹陷合并寰枢椎脱位患者的临床资料。所有患者均合并寰枕融合,其中16例(51.6%)合并Klippel-Feil综合征,10例(32.2%)合并小脑扁桃体下疝。31例患者均行单纯后路复位和枕颈固定融合手术治疗。术前、术后分别测量寰齿间距(ADI)、齿状突尖端超过Chamberlain线的距离、斜坡枢椎角,并比较其差异。随访方法包括临床和影像学随访。应用日本骨科协会(JOA)颈椎评分评价术后6个月的神经功能,复查CT评估植骨融合情况。结果31例患者均顺利完成枕颈固定融合手术,围手术期患者均未出现脑梗死、神经功能障碍加重。ADI由术前的(6.2±0.6)mm减少至术后的(2.2±0.3)mm(t=8.52,P<0.001),齿状突尖超过Chamberlain线的距离由术前的(11.3±3.0)mm减少至术后的(3.1±0.5)mm(t=12.65,P<0.001),斜坡枢椎角自术前的(125.6±6.5)°增至术后的(140.7±5.0)°(t=5.28,P<0.001)。术后1例患者出现枕骨板松动,1例出现取骨部位感染,2例术后出现复位丢失。所有患者均获随访,术后6个月随访时,JOA评分[(14.3±2.5)分]较术前[(11.2±3.1)分]改善(t=12.81,P<0.001)。术后3个月MRI检查提示,术前合并小脑扁桃体下疝和(或)脊髓空洞的患者出现不同程度的小脑扁桃体位置上移、脊髓空洞缩小;术后6个月CT检查结果提示,随访患者植骨融合成功,均实现骨性融合。结论单纯后路手术治疗先天性颅底凹陷合并寰枢椎脱位安全、有效,并发症少。Objective To assess the efficacy and safety of direct posterior reduction in the treatment of congenital basilar invagination(BI)complicated with atlantoaxial dislocation(AAD).Methods A retrospective analysis was conducted on the clinical data of 31 patients with BI combined with AAD treated at the Department of Neurosurgery,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from January 2018 to August 2021.The C1 assimilation was observed in all 31 patients.The C2-3 fusion(Klippel-Feil syndrome)and Chiari malformation was revealed in 16 patients(51.6%)and 10 patients(32.2%)respectively.All patients underwent reduction and occipitocervical fixation and fusion using a direct posterior approach.The preoperative and postoperative radiological measurements included anterior atlantodental interval(ADI),Chamberlain′s line violation(CLV),clivus-canal angle(CCA)were documented and compared using paired t-test.Clinical and imaging follow-up were performed.Neurological function 6 months after surgery was evaluated using the JOA scale.Bone fusion was evaluated based on CT results during follow-up period.Results All patients underwent surgery successfully.None of the cases had severe surgical complications such as cerebral infarction or aggravation of neurological dysfunction.Compared with those prior to operation,ADI(6.2±0.6 mm vs.2.2±0.3 mm,t=8.52,P<0.001)and CLV(11.3±3.0 mm vs.3.1±0.5 mm,t=12.65,P<0.001)decreased,while the CCA(125.6°±6.5°vs.140.7°±5.0°,t=5.28,P<0.001)increased post operation.Occipital plate loosening was found in 1 case,postoperative reduction was lost in 2 case and one patient suffered from infection in donor site of iliac crest bone graft.All patients were followed up.At 6 months post operation,the mean JOA score significantly improved from 11.2±3.1 to 14.3±2.5(t=12.81,P<0.001).Reduction of the syrinx size and regression of tonsillar herniation were observed in the patients which were preoperatively diagnosed with concomitant tonsillar

关 键 词：关节脱位 寰枢关节 神经外科手术 治疗结果 后路手术 

分 类 号：R651[医药卫生—外科学]