经口咽松解复位后路减压融合治疗复杂枕颈畸形

发布时间：2018-02-23 21:15

本文关键词： 枕颈畸形经口咽入路寰枢关节脱位松解　出处：《中国矫形外科杂志》2017年15期 　论文类型：期刊论文

【摘要】：[目的]探讨经口咽寰枢椎松解复位后路枕骨大孔扩大减压枕颈固定融合术治疗复杂枕颈畸形的临床疗效。[方法]回顾性分析2012年1月~2015年6月本科共收治并随访57例伴难复性寰枢关节脱位的复杂枕颈畸形患者的临床资料。采用持续颅骨牵引下经口咽寰枢椎松解复位+后路寰椎后弓切除枕骨大孔扩大减压枕颈固定植骨融合术治疗此类畸形,术前、术后1、3、6及12个月随访时行JOA评分和颈椎X线片、CT、MR检查,并测量齿状突超过Chamberlain线距离、延髓脊髓角(CMA)、寰齿前间隙(ADI)、枕大孔正中有效矢状径,所有患者根据手术前后JOA、VAS、NDI评分和测量影像学相关径线评价临床疗效。[结果]平均手术时间5.3 h,术中出血量62~220ml,术中置钉良好,未出现椎动脉损伤和脊髓损伤加重,术后鼻饲3~7 d,2周出院。术后无口咽部感染病例,枕颈部感染2例,经清创VSD负压吸引后均治愈。术前JOA评分6~12分,VAS评分0~7分,NDI评分8~40分,术后12个月JOA评分10~17,VAS评分0~4分,NDI评分5~19分,与术前比较差异有统计学意义。术后复查影像学检查示内固定稳定,植入骨块达骨性融合,术后齿状突超过腭枕线距离-10.00~6.90 mm;CMA 137.00°~159.50°,ADI值1.70~5.80 mm,枕大孔正中有效矢状径25.70~32.90 mm,分别与术前齿状突超过腭枕线(Chamberlain线)距离5.30~16.70 mm;CMA 109.00°~129.80°,ADI值5.30~9.10 mm;枕大孔正中有效矢状径6.00~18.80 mm,比较差异均有统计学意义。[结论]枕颈畸形采用经口咽寰枢椎松解复位后路枕骨大孔扩大减压枕颈固定融合术治疗,可使齿状突明显下移,纠正寰枢脱位,解除脊髓压迫,疗效满意。
[Abstract]:[objective] to investigate the clinical effect of the treatment of complex occipitocervical malformation by extended decompression and occipitocervical fusion through oropharynx atlantoaxial release and reduction. [methods] A retrospective analysis was made on the treatment of complex occipitocervical deformity from January 2012 to June 2015. The clinical data of 57 cases of complex occipitocervical malformation with irreducible atlantoaxial dislocation were investigated. Posterior pedicle resection of occipital foramen and extended occipitocervical fixation under continuous cranial traction through oropharyngeal atlantoaxial release and reduction. Fusion for the treatment of such deformities, Preoperative and 12 months follow-up were performed with JOA score and CT Mr of cervical vertebrae. The distance of odontoid process beyond Chamberlain line, medulla oblongata angle, anterior atlantoodontoid space, and the effective sagittal diameter of occipital foramen were measured. All the patients were evaluated according to the JOAA VASN NDI score before and after the operation and the radiography-related diameters. [results] the mean operative time was 5.3 h, the intraoperative blood loss was 62 ~ 220 ml, the nail placement was good, no vertebral artery injury and spinal cord injury were aggravated. Patients without oropharyngeal infection and 2 patients with occipitocervical infection were cured after debridement of VSD negative pressure. Preoperative JOA score ranged from 6 to 12 points and from 0 to 7 points. 12 months after operation, the JOA scores were 10 ~ 17, 0 ~ 4 and 5 ~ 19 respectively, which were significantly different from those before operation. The imaging examination showed that the internal fixation was stable, and the bone grafts were bony fused. After operation, the distance between the odontoid process and the occipital line was -10.00 卤6.90 mm, CMA 137.00 掳and 159.50 掳ADI was 1.70 卤5.80 mm, the median effective sagittal diameter of occipital foramen was 25.700.90 mm, which was 5.3016.70 mm longer than that before operation (CMA 109.00 掳129.80 掳ADI 5.309.10), and the median effective sagittal diameter of occipital foramen was 6.00 ~ 18.80 mm, respectively. [conclusion] the occipitocervical malformation was treated by transoropharyngeal atlantoaxial release reduction and extended occipital foramen decompression, occipitocervical fixation and fusion. The odontoid process can be obviously moved down, atlantoaxial dislocation can be corrected, spinal cord compression can be relieved, and the curative effect is satisfactory.
【作者单位】：昆明医科大学第一附属医院骨科;
【分类号】：R687.3

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