经口咽松解复位后路减压融合治疗复杂枕颈畸形的临床疗效分析

发布时间：2018-04-23 17:07

本文选题：枕颈畸形 + 口咽入路　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]回顾分析难复性复杂枕颈畸形病例,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月至2015年6月我科共收治并随访57例伴难复性寰枢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月、3月、6月及12月随访时行JOA、VAS、NDI评分和颈椎X线、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小时,术中出血量62～220ml(146±37ml),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天,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(8.281 ± 1.688),VAS 评分 0～7 分(3.158± 1.320),NDI评分8～40分(28.088±7.422),分别与术后12月JOA评分10～17分(15.228± 1.389),VAS 评分 0～4 分(1.316±0.929),NDI 评分 5～19 分(12.702±2.732),比较差异均有统计学意义(t值分别为-30.207,24.823,23.353,P0.05)。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(3.956mm±2.453),CMA 137.00～159.50°(147.991±5.418°),ADI 值 1.70～5.80mm(3.640±0.947mm),枕大孔正中有效矢状径25.70～32.90mm(29.918±1.792mm),轴位脊髓空洞最大直径0～5.32mm(1.720±1.316),分别与术前齿状突超过腭枕线(Chamberlain线)距离5.30～16.70mm(11.149±2.604),CMA 109.00～129.80°(120.774±5.859°),ADI 值 5.30～9.10mm(7.205±1.008mm),枕大孔正中有效矢状径 6.00～18.80mm(13.419±3.374mm),轴位脊髓空洞最大直径 2.37～9.42mm(6.727±1.977),比较差异均有统计学意义(t值分别为35.167,-163.512,189.485,-76.191,11.263,P0.05)。[结论]难复性复杂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 review and analyze the cases of complex complex occipital and cervical malformation, and to explore the clinical effect of the occipital cervical fixation with enlarged decompression and occipital fixation of occipital occipital through oropharyngeal atlantoaxial reduction and reduction. [Methods] a retrospective analysis of 57 cases of complex occipital neck with difficult atlantoaxial dislocation in our department from January 2012 to June 2015 was reviewed. The clinical data of the malformed patients. The JOA, VAS, NDI, and cervical X-ray, CT, MR examination, and the odontoid process exceeded Chamb before the operation were followed up in January, March, June and December. Erlain line distance, medulla oblongata angle (CMA), anterior atlantoodontoid space (ADI), the effective sagittal diameter of the occipital foramen, all patients were evaluated according to the JOA, VAS, NDI score and radiographic correlation diameter before and after the operation. [results] the average operation time was 5.3 hours, the amount of bleeding in the operation was 62 to 220ml (146 + 37ml), the intraoperative nailing was good and no vertebral artery loss appeared. The injuries and spinal cord injuries were aggravated, and the postoperative nasal feeding was 3~7 days and 2 weeks after operation. There were no pharynx infection cases and 2 cases of occipital and cervical infection after operation. After debridement VSD negative pressure, the preoperative JOA score was 6~12 points (8.281 + 1.688), VAS score was 0~7 (3.158 + 1.320), and NDI score was 8~40 (28.088 + 7.422), respectively, and JOA score 10~17 in December after the operation, respectively. (15.228 + 1.389), VAS score was 0~4 (1.316 + 0.929), NDI score was 5~19 (12.702 + 2.732), and the difference was statistically significant (t value was -30.207,24.823,23.353, P0.05). After operation, the imaging examination showed that the internal fixation was stable, the bone mass was implanted to the bone fusion, and the odontoid process exceeded the palatine occipital distance -10.00 to 6.90 mm (3.956mm) after the operation. + 2.453), CMA 137 ~ 159.50 (147.991 + 5.418 degrees), ADI value 1.70 ~ 5.80mm (3.640 + 0.947mm), the effective sagittal diameter of the occipital foramen was 25.70 to 32.90mm (29.918 + 1.792mm), and the maximum diameter of the cavities of the axial spinal cord was 0 to 5.32mm (1.720 + 1.316), and the distance between the anterior teeth and the palatine occipital line (Chamberlain line) was 5.30 to 16.70mm (CMA), CMA, respectively, CMA. 109 to 129.80 degrees (120.774 + 5.859 degrees), ADI value 5.30 ~ 9.10mm (7.205 + 1.008mm), the effective sagittal diameter of the occipital foramen was 6 to 18.80mm (13.419 + 3.374mm), and the maximum diameter of the cavities of the axial spinal cord was 2.37 to 9.42mm (6.727 + 1.977). The difference was statistically significant (t value was 35.167, -163.512189.485, -76.191,11.263, P0.05). [Conclusion] The complex and complex occipital neck malformation is treated with atlantoaxial loosening and reduction of occipital occipital cervical fixation with enlarged decompression of occipital occipital and posterior occipital cervical fusion, which can make odontoid process descend obviously, correct atlantoaxial dislocation and relieve spinal cord compression, and the curative effect is satisfactory.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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