C1-C2椎弓根螺钉—棒技术及颈枕融合术治疗寰枢椎脱位的疗效评价

发布时间：2018-05-03 09:21

本文选题：颈枕融合术 + C1-C2椎弓根螺钉技术　；参考：《郑州大学》2017年硕士论文

【摘要】：背景寰枢椎位于颅颈交界区(craniovertebral junction)内,颅颈交界区为连接颅骨与颈椎的特殊结构,比邻椎动脉、延髓及高位颈髓等结构。对于寰枢椎脱位(Atlantoaxial dislocation)的瘤患者来说,致病的主要因素是由于寰枢椎稳定性被破坏(Atlantoaxial instability)后所造成延髓及高位脊髓的压迫。本病变致残机率高、严重者可危及生命。随着内固定器械的发展和手术技术的进步,针对寰枢椎脱位,目前治疗方案多以后入路椎弓根钉-棒内固定为主。由于颅颈交界区的结构特殊造成此区域手术操作风险大,死亡率高,是目前研究的重点及难点。目的观察C1-C2椎弓根螺钉-棒技术及颈枕融合术治疗寰枢椎脱位的疗效。方法回顾性分析2012年12月至2016年6月在郑州大学第一附属医院神经外科接受后入路椎弓根钉-棒内固定技术治疗的55例寰枢椎脱位患者,根据病情选择并分别采用经后入路C1-C2椎弓根螺钉-棒技术及颈枕融合术治疗。术前使用JOA评分评估患者神经功能情况,使用X线、CT、3T磁共振、CT三维重建进行检查,观察患者寰枢椎前后根、椎弓根、寰枢关节、寰枕关节、椎动脉走形等情况并记录ADI值、齿状突与CL的距离值(记为CL)、CMA值。根据术前资料选择C1-C2椎弓根螺钉-棒技术及颈枕融合术进行治疗。术中观察并记录出血量、手术时间、寰枢椎复位及置钉等情况。术后记录患者一般情况及有无并发症等情况。随访6~30个月,随访时记录患者主诉、JOA评估、复查时CT和MRI所记录的ADI值、CL值、CMA值及生活质量评价表(SF-36生活质量评估表)与术前资料进行对比评估。根据术前、术后资料对比从而判定手术疗效。结果入组的55例患者中,35例(63.6%)患者接受颈枕融合术治疗,20例(36.6%)患者接受C1-C2寰枢椎椎弓根螺钉术治疗,所有患者术中未发生椎动脉出血、神经损伤等并发症。术中X线及CT显示置钉位置准确。术后影像学示全部患者植骨及内固定均良好。随访6~30个月,经颈枕融合术治疗组中32例(94%)患者症状较前缓解,2例(6%)症状无明显缓解,33(94%)例植骨及内固定均良好,1例(3%)因脑干大面积梗塞死亡,1例(3%)植骨融合失败。术后7天JOA评分由术前(10.8±1.7)分提升到(11.6±1.6)分,ADI值由术前(8.17±2.862)mm下降到(2.79±0.55)mm,CL值(8.1±5.5)下降至(3.1±1.5)mm,CMA(130.1±10.3)提高至(152.7±6.2)°差异均有统计学意义(P0.05)。末次随访JOA评分为13.2±1.7分,较术前及术后7天有明显差异(P0.05)。经C1-C2寰枢椎椎弓根螺钉术治疗组,19例(95%)患者主诉症状较前缓解,1例(5%)症状无明显缓解,全部20(100%)例植骨及内固定均良好。术后7天JOA评分由术前(11.3±1.4)分提升到(12.1±1.5)分,ADI值由术前(7.13±2.762)mm下降到(2.69±0.45)mm,CL值(9.1±4.6)下降至(3.4±1.7)mm,CMA(128.1±11.3)提高至(156.7±7.2)°差异均有统计学意义(P0.05)。末次随访JOA评分为13.9±1.4分,较术前及术后7天有明显差异(P0.05)。通过SF-36生活质量分别对两组患者术前、术后的生理健康及心理健康进行评估,结果有明显差异(p0.05)结论1、C1-2椎弓根螺钉技术及颈枕融合术治疗寰枢椎脱位安全有效。2、C1-2椎弓根螺钉技术及颈枕融合术治疗寰枢椎脱位后,术后患者生活质量明显提高。
[Abstract]:Background the atlantoaxial junction is located in the craniofacial junction (craniovertebral junction). The craniofacial junction is a special structure connecting the skull and the cervical spine, compared with the adjacent vertebral arteries, the medulla oblongata and the high cervical pulp. For the patients with atlantoaxial dislocation (Atlantoaxial dislocation), the main cause of the disease is the stability of the atlantoaxial instability (Atlanto Axial instability causes the compression of the medulla and the high position of the spinal cord. This lesion has a high disability rate and a serious life. With the development of the internal fixation apparatus and the progress of the surgical technique, the main treatment scheme is mainly pedicle screw rod internal fixation for atlantoaxial dislocation. The regional operation is the key and difficult point of the present study. Objective To observe the effect of C1-C2 pedicle screw rod technique and cervical occipital fusion in the treatment of atlantoaxial dislocation. Methods a retrospective analysis was made on the pedicle screw fixation in the Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University from December 2012 to June 2016. 55 patients with atlantoaxial dislocation were selected and treated with C1-C2 Shiumi Ne screw rod technique and cervical occipital fusion respectively. Preoperative JOA score was used to evaluate the patient's nerve function. X-ray, CT, 3T magnetic resonance, and CT 3D reconstruction were used to observe the anterior and posterior atlantoaxial roots, Shiumi Ne, atlantoaxial clearance. Section, atlantooccipital joint, vertebral artery shape, ADI value, distance value of odontoid and CL (CL), CMA value. Select C1-C2 pedicle screw rod technique and cervical occipital fusion according to preoperative data. Intraoperative observation and recording of bleeding, operation time, atlantoaxial reduction and nailing were recorded. The patients were followed up for 6~30 months, followed up for 6~30, JOA assessment, ADI value, CL value, CL value, CMA value, and quality of life assessment table (SF-36 life quality assessment table) compared with the preoperative data at the time of review. The results were compared with the preoperative and postoperative data to determine the effect of the operation. Results the results were determined in 55 patients. 35 (63.6%) patients received cervical occipital fusion and 20 (36.6%) underwent C1-C2 atlantoaxial pedicle screw operation. All patients had no vertebral artery bleeding and nerve injury during the operation. The X-ray and CT showed the position of the nail in the operation. The symptoms of 32 (94%) patients in the occipital fusion group were relieved, 2 cases (6%) had no obvious relief, 33 (94%) had good bone graft and internal fixation, 1 cases (3%) died of large area infarction of the brain stem, 1 cases (3%) failed in bone graft fusion. The JOA score of 94% days after operation was raised to (10.8 + 1.7) points, and the value of ADI decreased to (mm). 2.79 + 0.55) mm, CL value (8.1 + 5.5) decreased to (3.1 + 1.5) mm, CMA (130.1 + 10.3) increased to (152.7 + 6.2) degree difference (P0.05). The last follow-up JOA score was 13.2 + 1.7, compared with preoperative and postoperative 7 days (P0.05). All 20 (100%) cases of bone graft and internal fixation were all good. The JOA score was raised to (12.1 + 1.5) points before operation (11.3 + 1.4), and the value of ADI decreased from (7.13 + 2.762) mm to (2.69 + 0.45) mm, and CL value (9.1 + 4.6) dropped to (P0.05) mm, and CMA (P0.05) was statistically significant (P0.05). The JOA score of the last follow-up was 13.9 + 1.4 points, compared with the preoperative and 7 days after the operation (P0.05). The physiological health and mental health of the two groups were evaluated before and after the SF-36 quality of life respectively. The results were significantly different (P0.05) 1. The C1-2 pedicle screw technique and the cervical occipital fusion were safe and effective in the treatment of atlantoaxial dislocation, C 1-2 after pedicle screw fixation and occipital fusion for atlantoaxial dislocation, the quality of life of the patients was significantly improved.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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