颅底凹陷症的分型及其意义

Classification and its clinical significance of basilar invagination

中文关键词:  颅底凹陷症  分型  稳定型  不稳定型

英文关键词:Basilar invagination  Classification  Stable type  Unstable type

中文摘要:

  【摘要】 目的：探讨颅底凹陷症的分型方法，为其手术治疗方案的制定提供参考。方法：2007年3月~2010年3月我院收治颅底凹陷症患者70例，均行颅骨正侧位X线片及包含颅底部的颈椎CT和头颈部MRI检查，根据有无寰枢椎脱位或寰枕脱位将其分为稳定型和不稳定型，统计各型合并寰枕融合畸形、Chiari畸形、枢椎上关节面倾斜及脊髓空洞的例数，测量枕骨斜坡角、齿状突顶点到Chamberlain线的垂直距离和齿状突顶点到枕骨大孔连线的垂直距离，观察脊髓受压情况，记录手术方法。结果：20例为稳定型颅底凹陷症，其中合并Chiari畸形18例（90%），合并脊髓空洞15例（75%）；50例为不稳定型，其中合并Chiari畸形2例（4%），寰枕融合46例（92%），枢椎上关节面倾斜37例（74%），脊髓空洞43例（86%）。稳定型枕骨斜坡角为168°±5°，不稳定型为133°±11°，无统计学差异（P<0.05）；稳定型齿状突顶点与枕骨大孔线的垂直距离为0.5±0.3mm，不稳定型为-6.9±2.9mm，有统计学差异（P<0.05）；稳定型齿状突顶点与Chamberlain线垂直距离为-4.8±4.2mm，不稳定型为-5.6±3.7mm，无统计学差异（P>0.05）。20例稳定型患者中，脊髓前方受压2例、后方受压11例、前后方均受压7例，均采用后颅窝减压手术治疗；50例不稳定型患者中，脊髓前方受压44例、前后方均受压6例，均采用经口咽前路复位钢板内固定手术治疗。结论：根据有无寰枢椎脱位或寰枕脱位可以将颅底凹陷症分为稳定型和不稳定型，这一分型方法对于正确认识两种不同类型颅底凹陷症的解剖学和临床特点，从而采取合理的手术方法进行治疗具有重要意义。

英文摘要:

  【Abstract】 Objective：To investigate the classification of basilar invagination so as to provide a criterion for surgery determination.Method：70 cases suffering basilar invagination determined by radiography，CT and MRI from March 2007 to March 2010 in our hospital were divided into two groups（stable group and unstable group） based on present of atlas-occipital or atlas-axis dislocation.The deformities such as occipital-atlas fusion，Chiari malformation，slippage of the axis facets，syringomyelia were recorded.Several parameters including clivus slope，distance from odontoid to Chamberlain line and distance form odontoid to foramen magnum line were measured，and the spine medulla compression and the surgical approach of each group were recorded respectively.Result：20 cases were termed as stable and 50 as unstable.Among the stable group，there were 18 Chiari deformity（90%） and 15 syringomyelia（75%）；while among the unstable group，there were 2 Chiari deformity （4%），46 occipital-atalas fusion（92%），37 slippage of upper facets（74%），and 43 syringomyelia（86%）.And the clivus slope angle was 168°±5° and 133°±11° for stable and unstable group respectively（P<0.05）；the distance from odontoid to the Chamberlain line was -4.8±4.2mm and -5.6±3.7mm for stable and unstable group respectively（P>0.05）；and the distance form odontoid to the foramen magnum line was 0.5±0.3mm and -6.9±2.9mm for stable and unstable group respectively（P<0.05）.In the stable group，2 cases complicated with ventral medulla compression，11 with dorsal and 7 cases with both underwent the posterior cranial fossa decompression；while all 50 unstable cases（44 with ventral and 6 with both ventral and dorsal medulla compressions） experienced transoral anterior release and instrumentation.Conclusion：The basilar invagination can be divided into two types based on present of atlas-occipital or atlas-axis dislocation，which is used to differentiate the anatomic and clinical characters for both groups and to determine the correspondent surgical approach.