经口咽齿状突下移技术治疗颅底凹陷症伴寰枢椎脱位的疗效

发布时间：2018-03-20 08:48

本文选题：经口咽入路　切入点：颅底凹陷症　出处：《广东医学》2017年24期 　论文类型：期刊论文

【摘要】：目的研究经口前路寰枢椎复位植骨融合内固定术(TARP)手术将齿状突下移、寰枢椎内固定治疗颅底凹陷症的临床疗效和相关影像学参数,介绍关于TARP手术治疗颅底凹陷症的相关临床经验。方法回顾性分析21例颅底凹陷症患者,年龄21~64岁[平均(38±11.1)岁]。所有患者均采用TARP手术进行治疗,评估术前、术后JOA评分,延髓脊髓角等相关临床疗效参数和影像学参数,20例患者(20/21)平均随访(12.5±7.6)个月,1例患者因骨质疏松症,术后出现螺钉松动,后失访。将20例患者术前、术后参数,使用配对样本t检验进行统计学分析。结果术后20例患者的症状均较术前有不同程度改善,术前JOA评分平均(12.75±3.31)分(n=20),术后(15.9±1.52)分(n=20),改善率为76%;术后的影像学资料提示,患者延髓脊髓角平均较术前改善,由术前的(128.7±11.9)°(n=20),改善为术后的(156.5±8.1)°(n=20)(P0.01)。结论 TARP手术的复位功能和术中的颅骨牵引,可以即时将颅底凹陷症的齿状突上移,对颈脊髓起到直接减压、固定的作用,其临床效果明显,值得推广。
[Abstract]:Objective to study the clinical effect and imaging parameters of transoral atlantoaxial reduction and fusion internal fixation (TARP) in the treatment of cranial base depression by moving the odontoid process down and fixing the atlantoaxial internal fixation. This paper introduces the clinical experience of TARP operation in the treatment of skull base depression. Methods 21 patients with skull base depression, aged 21 to 64 years (mean 38 卤11. 1) years, were analyzed retrospectively. All patients were treated with TARP operation, and JOA scores were evaluated before and after operation. The clinical and imaging parameters of spinal cord horn and other related parameters of medulla oblongata were 20 / 21. The mean follow-up time was 12.5 卤7.6) months, 1 patient suffered from osteoporosis, the screw loosened after operation, and the postoperative parameters were lost in 20 patients before and after operation. Results the symptoms of 20 patients were improved in varying degrees after operation. The average JOA score was 12.75 卤3.31% before operation, and 15.9 卤1.52% after operation, the improvement rate was 76%. The angle of medulla oblongata was improved from 128.7 卤11.9 掳to 156.5 卤8.1 掳P0.01.Conclusion the reduction function of TARP operation and the cranial traction during operation can immediately move the odontoid process of the skull base depression and directly decompress the cervical spinal cord. Fixed effect, its clinical effect is obvious, is worth popularizing.
【作者单位】：广州军区广州总医院脊柱二科;
【基金】：广东省自然科学基金资助项目(编号:2014A030313600)
【分类号】：R687.3

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