先天性颅底凹陷症的细化分型及临床分析
发布时间：2018-11-18 19:12
【摘要】：目的探讨先天性颅底凹陷症的细化分型及临床特征。方法回顾性分析2005年6月至2013年12月在我院收治的139例颅底凹陷症患者的完整资料,在Goel分型基础之上根据其是否合并脊髓空洞将先天性颅底凹陷症进一步分为四型:1 BIa+0型:颅底凹陷,寰齿间距增大,不合并脊髓空洞;2 BIa+S型:颅底凹陷,寰齿间距增大,合并脊髓空洞;3 BIb+0型:颅底凹陷,寰齿间距无增大,不合并脊髓空洞;4 BIb+S型:颅底凹陷,寰齿间距无增大,合并脊髓空洞。均从患者年龄、性别、体重、临床表现、颈椎MRI、MRI-Cine、颅颈交界区三维CT重建、手术前后JOA评分及相关神经功能等方面进行分析。结果139例患者中,BIa+0型31例(22.3%),BIa+S型45例(32.4%),BIb+0型21例(15.1%),BIb+S型42例(30.2%),其中BIa+0型和BIb+0型以脑干受压引起的四肢无力、锥体束征及小脑损害引起的平衡及共济失调为主,BIa+S型和BIb+S型既含有脑干受压症状,同时还含有以脊髓中央管周围受损引起的节段性分离性感觉障碍及肌肉萎缩等脊髓空洞症状。四种分型在年龄、性别及体重因素上不存在统计意义上的差异性(p0.05)。分别在手术前后,对患者进行了JOA评分及对可出现潜在神经损伤的相关功能进行评测,并对结果进行统计分析。结果表明,经分型诊断治疗后,患者的病情普遍能得到改善。JOA评分中:BIa+0型病人分值可由术前的10.97上升至术后的12.45,术后JOA评分平均提高30.78%;BIa+S型病人分值可由术前的10.78上升至术后的12.76,术后JOA评分平均提高35.09%;BIb+0型病人分值可由术前的11.71上升至术后的13.57,术后JOA评分平均提高36.57%;BIb+S型病人分值可由术前的10.95上升至术后的12.71,术后JOA评分平均提高31.92%。潜在神经损伤的相关功能评测中,经分型诊断治疗后,其中各组的术后改善率分别为:BIa+0,86.5%;BIa+S,88.4%;BIb+0,83.7%;BIb+S,79.1%。结论对于先天性颅底凹陷症实施有效的临床治疗,需要我们对颅颈交界区部位的神经生理及骨性解剖结构取得深入的研究了解。本课题中依托颈椎MRI、MRICine及颅颈交界区三维CT重建检查,可清晰显示颅颈交界区病变及解剖结构,根据寰枢椎脱位及脊髓空洞的有无,将先天性颅底凹陷症细分为四型,可准确反映复杂先天性颅底凹陷症复杂的临床病理特征,促进病人的临床康复,降低临床手术风险,并为手术方案的制订提供可靠依据。
[Abstract]:Objective to study the classification and clinical features of congenital skull base depression. Methods the complete data of 139 patients with skull base depression admitted in our hospital from June 2005 to December 2013 were retrospectively analyzed. On the basis of Goel classification, congenital skull base depression was further divided into four types according to whether it was combined with syringomyelia: (1) BIa 0 type: skull base depression, atlantodentate space increased, and syringomyelia was not associated with syringomyelia; (2) BIa S type: cranial base depression, atlantodentate space increased, accompanied with syringomyelia; 3 BIb 0 type: skull base depression, atlantodentate space was not increased, without syringomyelia; 4 BIb S type: skull base depression, atlantodentate space was not increased, and syringomyelia was associated with syringomyelia. All patients were analyzed from age, sex, body weight, clinical manifestation, three-dimensional CT reconstruction of craniocervical junction of cervical MRI,MRI-Cine, JOA score and related nerve function before and after operation. Results among the 139 patients, 31 cases (22.3%) were BIa 0 type), BIa S (32.4%), BIb 0 type (42 cases) (15.1%), BIb S type 42 cases), and (32.4%), BIb 0 type (42 cases (30.2%). Among them, BIa 0 and BIb 0 were characterized by limb weakness caused by brainstem compression, pyramidal beam sign and balance and ataxia caused by cerebellar damage., BIa S and BIb S type had both brainstem compression symptoms. At the same time, there are some syringomyelia symptoms such as segmental dissociative sensory disorder and muscular atrophy caused by injury around the central canal of spinal cord. There was no statistical difference in age, sex and body weight among the four types (p0.05). Before and after operation, the patients were evaluated with JOA score and related functions of potential nerve injury, and the results were statistically analyzed. The results showed that after the diagnosis and treatment, the patients' condition could be improved generally. Among the JOA scores, the scores of BIa 0 patients increased from 10.97 before operation to 12.45 after operation, and the average JOA score increased 30.78% after operation. The score of BIa S patients increased from 10.78 before operation to 12.76 after operation, and the JOA score increased 35.09 on average after operation. The score of BIb 0 patients increased from 11.71 before operation to 13.57 after operation, and the JOA score increased 36.57 on average after operation. The score of BIb S patients increased from 10.95 before operation to 12.71 after operation, and the average JOA score increased 31.922 after operation. In the functional evaluation of the potential nerve injury, the improvement rate of each group after the diagnosis and treatment of the potential nerve injury was as follows: BIa 0 / 86.5 / BIa / S88.4 / BIb / 83.7B / S 79.1 / B respectively. Conclusion the effective clinical treatment of congenital skull base depression requires us to study the neurophysiology and bone anatomy of craniocervical junction. Based on MRI,MRICine of cervical vertebra and 3D CT reconstruction of craniocervical junction, the lesion and anatomical structure of craniocervical junction can be clearly displayed. According to the presence or absence of atlantoaxial dislocation and syringomyelia, congenital skull base depression can be subdivided into four types. It can accurately reflect the complex clinicopathological characteristics of complex congenital skull base depression, promote the clinical rehabilitation of patients, reduce the clinical operation risk, and provide reliable basis for the formulation of surgical plan.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1
本文编号：2340926
[Abstract]:Objective to study the classification and clinical features of congenital skull base depression. Methods the complete data of 139 patients with skull base depression admitted in our hospital from June 2005 to December 2013 were retrospectively analyzed. On the basis of Goel classification, congenital skull base depression was further divided into four types according to whether it was combined with syringomyelia: (1) BIa 0 type: skull base depression, atlantodentate space increased, and syringomyelia was not associated with syringomyelia; (2) BIa S type: cranial base depression, atlantodentate space increased, accompanied with syringomyelia; 3 BIb 0 type: skull base depression, atlantodentate space was not increased, without syringomyelia; 4 BIb S type: skull base depression, atlantodentate space was not increased, and syringomyelia was associated with syringomyelia. All patients were analyzed from age, sex, body weight, clinical manifestation, three-dimensional CT reconstruction of craniocervical junction of cervical MRI,MRI-Cine, JOA score and related nerve function before and after operation. Results among the 139 patients, 31 cases (22.3%) were BIa 0 type), BIa S (32.4%), BIb 0 type (42 cases) (15.1%), BIb S type 42 cases), and (32.4%), BIb 0 type (42 cases (30.2%). Among them, BIa 0 and BIb 0 were characterized by limb weakness caused by brainstem compression, pyramidal beam sign and balance and ataxia caused by cerebellar damage., BIa S and BIb S type had both brainstem compression symptoms. At the same time, there are some syringomyelia symptoms such as segmental dissociative sensory disorder and muscular atrophy caused by injury around the central canal of spinal cord. There was no statistical difference in age, sex and body weight among the four types (p0.05). Before and after operation, the patients were evaluated with JOA score and related functions of potential nerve injury, and the results were statistically analyzed. The results showed that after the diagnosis and treatment, the patients' condition could be improved generally. Among the JOA scores, the scores of BIa 0 patients increased from 10.97 before operation to 12.45 after operation, and the average JOA score increased 30.78% after operation. The score of BIa S patients increased from 10.78 before operation to 12.76 after operation, and the JOA score increased 35.09 on average after operation. The score of BIb 0 patients increased from 11.71 before operation to 13.57 after operation, and the JOA score increased 36.57 on average after operation. The score of BIb S patients increased from 10.95 before operation to 12.71 after operation, and the average JOA score increased 31.922 after operation. In the functional evaluation of the potential nerve injury, the improvement rate of each group after the diagnosis and treatment of the potential nerve injury was as follows: BIa 0 / 86.5 / BIa / S88.4 / BIb / 83.7B / S 79.1 / B respectively. Conclusion the effective clinical treatment of congenital skull base depression requires us to study the neurophysiology and bone anatomy of craniocervical junction. Based on MRI,MRICine of cervical vertebra and 3D CT reconstruction of craniocervical junction, the lesion and anatomical structure of craniocervical junction can be clearly displayed. According to the presence or absence of atlantoaxial dislocation and syringomyelia, congenital skull base depression can be subdivided into four types. It can accurately reflect the complex clinicopathological characteristics of complex congenital skull base depression, promote the clinical rehabilitation of patients, reduce the clinical operation risk, and provide reliable basis for the formulation of surgical plan.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1
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