寰椎横突外侧骨质磨除术治疗颈内静脉受压狭窄所致脑鸣的疗效分析  

Efficacy analysis of removal of the transverse process of the atlas for the treatment of cranial tinnitus caused by compression and stenosis of internal jugular vein

作　　者：朱广通 毛贝贝 周陈 黄辉 关峰 胡志强 吉训明 Zhu Guangtong;Mao Beibei;Zhou Chen;Huang Hui;Guan Feng;Hu Zhiqiang;Ji Xunming(Department of Neurosurgery,Bejing Shjitan Hospital,Capital Medical University,Beijing 100038,China;Capital Medical University Brain Disorders Research Center,Beijing Institute of Brain Disorders,Bejing 100069,China)

机构地区：[1]首都医科大学附属北京世纪坛医院神经外科,北京100038 [2]首都医科大学脑重大疾病研究中心,北京脑重大疾病研究院,北京100069

出　　处：《中华神经外科杂志》2024年第6期596-601,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(82171858)。

摘　　要：目的探讨寰椎横突外侧骨质磨除术治疗颈内静脉狭窄所致脑鸣的手术方法和疗效。方法采用回顾性队列研究设计,分析2020年9月至2022年9月首都医科大学附属北京世纪坛医院神经外科收治的32例颈内静脉上段狭窄所致脑鸣患者的临床资料。术前采用颈静脉CT和颈静脉超声检查进行评估,证实为寰椎横突压迫导致颈内静脉上段狭窄。根据临床症状特点将32例患者分为脑鸣进展期(包括脑鸣早期+中期)(23例)和脑鸣持续期患者(9例)。27例患者行单侧寰椎横突外侧骨质磨除术,5例行双侧寰椎横突外侧骨质磨除术。观察手术相关的并发症情况。术后行临床和影像学随访,评估指标为术后1周、3个月的症状,颈内静脉形态和血流的改善情况。结果32例患者中,4例出现手术相关并发症,包括术中颈内静脉损伤1例,术后出现耸肩及转颈力弱1例,颈肩不适感1例,切口感染1例。术后3个月,脑鸣及其他伴随症状的总改善率为62.5%(20/32),其中脑鸣症状的改善率为28.1%(9/32);颈内静脉狭窄的改善率为84.4%(27/32);血流速度的改善率为75.0%(24/32)。脑鸣进展期较脑鸣持续期患者术后颈内静脉血流速度的改善程度更明显(Ζ=2.06,P=0.039)。结论对于颈内静脉受压狭窄所致脑鸣患者,寰椎横突外侧骨质磨除术可有效减轻颈内静脉上段的受压狭窄,改善颈内静脉的形态和血流速度,缓解患者的临床症状,且并发症较轻微。Objective To investigate the surgical method and efficacy of decompression of the internal jugular vein(IJV)by partially removing the transverse process of the atlas in the treatment of cranial tinnitus caused by compression and stenosis of the IJV.Methods A retrospective analysis was conducted on the clinical data of 32 patients with stenosis of the upper segment of the IJV admitted to the Department of Neurosurgery,Beijing Shijitan Hospital,Capital Medical University from September 2020 to September 2022.Before operation,the stenosis of IJV caused by the compression of transverse process of atlas was confirmed by using color Doppler ultrasound imaging and CT venography.Based on the characteristics of clinical symptoms,32 patients were divided into patients in the progressive stage(including early and middle stage of cranial tinnitus)(23 cases)and those in the continuous stage(9 cases).A total of 27 patients underwent unilateral partial grinding decompression of transverse process of atlas,and the other 5 patients underwent bilateral partial grinding decompression of transverse process of atlas.Surgery-related complications were documented.Postoperative clinical and imaging follow-up was performed,and the evaluation indicators included the symptom improvement,restoration of IJV morphology and improvement of blood flow at 1 week and 3 months post operation.Results Among the 32 patients,surgical complications included 1 case of intraoperative IJV injury,1 case of weakness of shrug and neck rotation,1 case of neck and shoulder discomfort,and 1 case of incision infection.Three months after surgery,the total improvement rate of postoperative tinnitus and accompanying symptoms,tinnitus only,IJV morphology,blood flow was 62.5%(20/32),28.1%(9/32),84.3%(27/32)and 75.0%(24/32),respectively.Improvement of the IJV blood flow after surgery was more significant in patients with tinnitus in the progressive stage(early and middle stage)than in those with sustained tinnitus(Z=2.06,P=0.039).Conclrision Decompression of IJV by par

关 键 词：颈静脉 减压术 外科 脑鸣 治疗结果 并发症 寰椎横突外侧骨质磨除 

分 类 号：R653[医药卫生—外科学]