后路关节间撑开复位内固定术治疗Goel A型颅底凹陷的临床疗效  

Posterior intra-articular distraction and internal fixation to treat Goel type A basilar invagination

作　　者：戚茂杨 孟洪锋 张博彦 辛宗 关健 段婉茹[1] 菅凤增[1] 陈赞[1] QI Maoyang;MENG Hongfeng;ZHANG Boyan;XIN Zong;GUAN Jian;DUAN Wanru;JIAN Fengzeng;CHEN Zan(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Spine Center,China International Neuroscience Institute(CHINA-INI),Lab of Spinal Cord Injury and Functional Reconstruction,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,中国国际神经科学研究所脊柱中心,首都医科大学宣武医院脊髓损伤与功能重建实验室,北京100053

出　　处：《中华骨与关节外科杂志》2023年第8期687-692,共6页Chinese Journal of Bone and Joint Surgery

基　　金：中央高水平医院临床科研业务费资助(2022-PUMCH-D-004);北京市医院管理中心临床医学发展专项经费资助(XMLX202138);北京市医院管理局青年人才培养“青苗”计划(QML20210801);中国医学科学院医学与健康科技创新工程项目(CIFMS#2021-1-I2M-025);北京市自然科学基金-海淀原始创新联合基金资助项目(L212039);首都临床特色诊疗技术研究及转化应用(Z221100007422019)。

摘　　要：目的:评估后路关节间撑开复位内固定技术治疗Goel A型颅底凹陷的临床疗效。方法:回顾性分析2020年6月至2021年2月就诊的30例Goel A型颅底凹陷患者的临床资料,其中男11例,女19例,年龄15~64岁,平均(39.3±13.0)岁。所有患者均行后路关节间撑开复位内固定术,收集并分析术前、术后和随访期间影像学及症状学资料。结果:所有患者手术时间为116~262 min,平均(182.6±18.2)min;失血量为50~200 mL,平均(144±25)mL,未出现血管神经损伤或硬脊膜损伤。30例患者随访时间为12~26个月,平均(18.6±4.5)个月。30例患者中有8例存在脊髓空洞,术后1年随访中脊髓空洞均有明显缩小或节段缩短。术后6个月,28例(93.3%)患者出现实体骨融合。2例(6.7%)患者至术后1年随访实现了实体骨融合。随访过程中未出现融合器塌陷和高度丢失等情况。日本骨科学会(JOA)评分从术前的(13.6±0.4)分提高到术后1年的(15.7±0.3)分,整体症状缓解率达96.7%,差异有统计学意义(P=0.001)。1例患者术后发生轻症肺炎,应用敏感抗生素1周后缓解;1例新发肢体麻木症状,康复治疗3个月后缓解。结论:后路关节间撑开复位内固定技术可安全有效地治疗Goel A型颅底凹陷。Objective:To evaluate the clinical efficacy of posterior intra-articular distraction and internal fixation in patients with Goel type A basilar invagination(atlantoaxial dislocation with basilar invagination).Methods:Clinical data of 30 patients with atlantoaxial dislocation and basilar invagination,who were treated at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,from June 2020 to February 2021 were retrospectively analyzed.There were 11 males and 19 females with an average age of(39.3±13.0)years(range,15-64 years).All the patients underwent posterior intra-articular distraction and internal fixation,and the imaging and clinical data were collected and analyzed before surgery,after surgery,and at the follow-up periods.Results:The operative time ranged from 116 min to 262 min,with a mean of(182.6±18.2)min.The blood loss ranged from 50 to 200 mL,with a mean of(144±25)mL.There was no vascular nerve injury or dural injury.The mean duration of follow up was(18.6±4.5)months(range,12-26 months). Of the patients, 8 had syringomyelia. At one year after surgery, all patients had a significant reduction of the syringomyelia. At 6-month follow-up, 28 patients (93.3%) had a bone fusion, and 2 patients (6.7%) had bone fusion one year after surgery. No cage collapse or height loss occurred during follow up. The Japanese Orthopaedic Association (JOA) score improved from 13.6±0.4 preoperatively to 15.7±0.3 one year after surgery, with a syndrom remission rate of 96.7% (P=0.001). One patient developed mild postoperative pneumonia who recovered after one-week sensitive antimicrobial agents, and one had new onset of limb numbness who recovered after 3 months of rehabilitation. Conclusions: The posterior intra-articular distraction and internal fixation technique can safely and effectively treat patients with Goel type A basilar invagination.

关 键 词：颅底凹陷 寰枢椎脱位 关节间撑开 

分 类 号：R682.1[医药卫生—骨科学]