颅颈交界区畸形的临床分类方法和颈后入路手术治疗策略的研究

发布时间：2018-03-19 14:29

本文选题：颅颈交界区畸形　切入点：脊髓空洞症　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景颅颈交界区畸形的发生发展既有先天胚胎发育因素,又有后天病理生理学及生物力学改变的影响。表现形式多样,很多情况下多种畸形并存,错综复杂。大多数伴有典型相关症状颅颈交界区畸形的首选治疗仍然是外科手术治疗,后路减压与矫形复位内固定术逐渐成为外科治疗的主流术式。目的目前对于颅颈交界区畸形的分类和治疗策略仍有争论。本文通过回顾分析大宗临床病例治疗探讨颅颈交界区畸形新的分类方法和个性化手术治疗策略。方法收集2012年3月18日-2016年12月24日山东省立医院神经外科收治明确诊断的颅颈交界区畸形并行手术治疗的患者110例,其中男38例,女72例,年龄12-67岁。试依据临床表现和明确的相关影像学诊断,大体将其归为三型,一型:Chiari畸形(Chiari malformation,CM);二型:寰枢椎脱位;三型:颅底凹陷。有时还可多种畸形并存且合并脊髓空洞症(syringomyelia,SM)等。手术技术有减压技术、矫形复位技术、内固定技术,可单独行后颅窝减压术或联合矫形复位术和内固定术。收集患者术前及术后临床症状缓解情况、手术并发症等情况;并随访3～48月,观察症状缓解、并发症等,并依据Lavender和Symon的临床疗效标准与颈椎 JO A(Japanese Orthopaedic Association Score for Cervical)评分系统对患者进行术前术后评估。利用统计学方法对结果进行分析,探讨显微外科治疗治疗颅颈交界区畸形的方法及疗效。结果随访到颅颈交界畸形术后病人102例;单纯后路减压病人50例,其中硬膜外减压的病人31例,硬膜下减压的病人19例;后路减压合并枕颈融合的病人44例;后路减压合并枕颈融合的病人例的病人有8例。依据Lavender和Symon的临床疗效标准;术后3个月内的总有效率是86.27%,术后6个月以上的总有效率是92.16%;依据颈椎JOA评分系统:术后3个月内的治疗改善率是83.17%,术后6个月以上的治疗改善率是84.04%。手术前和手术后随访的临床疗效和颈椎JOA评分存在显著改善,手术前和手术后随访的临床疗效和颈椎JOA评分存在显著的相关关系,手术对于改善病人术后的临床疗效和颈椎JOA评分具有统计学意义(P0.05)。结论根据不同临床表现和影像学表现对颅颈交界区畸形复杂性作充分评估,制定个性化手术方案,可明显改善病人预后,减少术后并发症,提高病人日常生活质量。颈后入路减压手术是颅颈交界区畸形有效合理的治疗方式,减压的术式以及固定融合策略仍存在争议,有待更多临床数据的积累。颈后入路复位固定融合技术可以解决绝大多数的颅颈交界区畸形的矫形问题,安全有效,可以认为是首选手术方式。研究意义根据临床症状和影像学检查对先天性颅颈交界畸形采用临床分类的方法,并选择个体化的颈后入路手术方案对提高手术成功率和改善患者预后可能具有一定的意义。
[Abstract]:The development background of craniocervical junction malformation is the inherent factor of embryonic development, and the impact of acquired pathophysiology and biomechanics. Diverse forms, in many cases a variety of abnormalities coexist, perplexing. The most preferred treatment area malformation associated with typical symptoms of craniocervical junction is still the surgical treatment of posterior decompression and orthopedic fixation has gradually become the mainstream of surgical treatment for craniocervical junction. The purpose of the classification and treatment strategy of region malformation is controversial. This paper reviews the analysis of clinic treatment of craniocervical junction malformation new classification method and individualized surgical treatment. Methods from March 18, 2012 December 24th -2016 years in the Department of Neurosurgery of Shangdong Province-owned Hospital from the diagnosis of craniocervical junction malformation parallel operation treatment in 110 cases of patients, including 38 cases of male and female In 72 cases, age 12-67. Test based on the clinical manifestations and related image clear diagnosis, generally classified into three types, one type: Chiari malformation (Chiari malformation, CM); type two: atlantoaxial dislocation; type three: the sag. Sometimes also can coexist with various deformities with spinal cord syringomyelia (syringomyelia, SM). The surgical technique with decompression technique, orthopedic reduction, internal fixation, posterior fossa decompression can alone or combined with orthopedic reposition and internal fixation. The relief of clinical symptoms of patients were collected before and after surgery, surgical complications; and the follow-up of 3~48 months, to observe the symptoms and complications so, according to the clinical curative effect of standard Lavender and Symon and A (Japanese Orthopaedic Association cervical JO Score for Cervical) for patients with preoperative and postoperative assessment scoring system. Using statistical methods to analyze the results of microsurgical treatment. Treatment of craniocervical junction deformity and the curative effect. Results 102 patients were followed up with malformation of craniocervical junction; simple posterior decompression in 50 patients, including 31 cases of epidural decompression in patients with subdural decompression in 19 patients; 44 patients with posterior decompression and occipitocervical fusion of the patients after the road; decompression and occipitocervical fusion of the patients in the 8 cases. On the basis of clinical curative effect of standard Lavender and Symon; within 3 months after operation, the total efficiency is 86.27%, after more than 6 months the total efficiency is 92.16%; on the basis of cervical JOA scoring system: after 3 months of treatment in the improvement rate 83.17%, postoperative treatment for more than 6 months to improve the rate of 84.04%. before and after surgery and the clinical curative effect of cervical JOA score significantly improved follow-up, preoperative and postoperative clinical curative effect and follow-up of cervical JOA score are significantly related to the operation, to improve the postoperative patients The clinical curative effect and the cervical JOA score was statistically significant (P0.05). Conclusion according to different clinical manifestations and radiological manifestations of craniocervical junction malformation complex to evaluate, develop personalized operation scheme, can significantly improve the prognosis of patients, reduce the postoperative complications, improve the quality of daily life patients. Posterior approach decompression is cranial cervical junction malformation effective treatment, surgical decompression and fixation and fusion strategy is still controversial, needs more clinical data accumulation. Cervical posterior fixation and fusion technology can solve most of the craniocervical junction malformation correction problem, safe and effective, can be considered as the preferred surgical method. According to the research significance the clinical symptoms and imaging methods with the clinical classification of malformation of congenital craniovertebral junction, and the choice of individual cervical posterior surgery program on the master were successfully provided The rate and improvement of the patient's prognosis may be of certain significance.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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