经口寰枢椎复位内固定术治疗颅底凹陷症合并脊髓空洞症的疗效

Clinical efficacy of TARP for treatment of basilar invagination with syringomyelia: a report of 32 cases

中文关键词:  颅底凹陷症  脊髓空洞症  经口寰枢椎复位钢板  内固定术  疗效

英文关键词:Basilar invagination  Syringomyelia  Transoral atlantoaxial reduction plate  Internal fixation  Clinical efficacy

中文摘要:

  【摘要】 目的：探讨经口寰枢椎减压复位植骨融合内固定术治疗颅底凹陷症合并脊髓空洞症患者的效果。方法：2005年3月~2011年7月共收治75例颅底凹陷症患者，其中35例合并脊髓空洞症患者中32例获得随访，男9例，女23例，年龄23~74岁，病程6~372个月。12例伴Arnold-Chiari畸形，7例伴寰枢椎脱位，1例伴寰枕融合畸形，2例伴颈椎病，1例伴Klippel-Feil综合征。均有脊髓神经功能受损的症状和体征，术前JOA评分3~15分，ASIA分级B级4例，C级8例，D级20例。术前脑干脊髓角103.4°~137.5°，平均123.3°±6.4°，脊髓空洞体积0.10~15.10cm3。均采用经口寰枢椎减压复位植骨融合TARP内固定术治疗，观察患者术后临床症状改善、脑干脊髓角改变情况，统计术中、术后并发症，随访脊髓空洞改变和植骨融合情况。结果：患者均顺利完成手术，术中未发生脊髓损伤及大出血等并发症。术后1例患者诉颈部不适感，2例患者诉咽喉部不适感，经对症处理后症状缓解；1例患者出现切口感染，拆除内固定行后路寰枕融合术，其余患者均未出现并发症。随访12~25个月，平均15个月，脑干脊髓角恢复至145.6°~165.3°，平均161.3°±5.1°；末次随访时JOA评分改善到10~16分，平均13.8±1.8分，平均改善率为58.1%；15例患者ASIA分级较术前提高1~2级。术后1年MRI复查显示30例脊髓空洞体积缩小或消失，1例脊髓空洞无改变，1例脊髓空洞变大。随访期间内固定无移位，植骨融合良好。结论：经口寰枢椎减压复位植骨融合内固定术治疗颅底凹陷症合并脊髓空洞症不仅能使齿状突获得解剖复位，解除脊髓压迫，还可使脊髓空洞缩小，患者临床症状明显改善，但远期疗效仍需进一步观察。

英文摘要:

  【Abstract】 Objectives: To investigate the effect of transoral atlantoaxial reduction and plate internal fixation for the treatment of basilar invagination with syringomyelia. Methods: From March 2005 to July 2011, 75 cases with basilar invagination were treated surgically. Of them, 35 patients were combined with syringomyelia, 32 cases of whom were followed up. There were 9 males and 23 females, aged from 23 to 74 years, with the course of disease of 6 to 372 months. 12 cases presented with Arnold-Chiari malformation, 7 cases with atlantoaxial dislocation, 1 patient with atlantooccipital fusion, 2 patients with cervical spondylosis and 1 patient with Klippel-Feil syndrome. All patients had signs and symptoms of spinal cord dysfunction, and the preoperative JOA score was 3-15 points. According to ASIA scale, there were 4 cases with grade B, 8 grade C, 20 grade D. Preoperative brainstem spinal cord angle was 123.3°±6.4° and syringomyelia size was 0.10~15.10cm3. All cases underwent TARP instrumentation, the postoperative improvement of neurofunction, brain stem spinal cord angle were recorded. The postoperative complications, follow-up changes in syringomyelia and bone graft fusion were also recorded. Results: All patients had successful surgery, with no neurovascular injury. After operation, 1 patient complained of neck discomfort, 2 cases complained of throat discomfort, which wereresolved after corresponsive treatment; 1 case had incision infection, which healed by removal of anterior instrument and posterior instrumentation; the remaining patients presented with no complication. The post-operative brainstem spinal cord angle recovered to 145.6°-165.3°, with an average of 161.3°±5.1°; JOA score improved to 10 to 16 points(average, 13.8±1.8), with an average improvement rate of 58.1%. 15 cases had ASIA scale improved. After 1 year, syringomyelia size of 30 cases shrank or disappeared, syringomyelia size of 1 case remained unchange, 1 case had syringomyelia size extended. No instrument failure was noted and all patients got bony fusion. Conclusions: Transoral atlantoaxial reduction and plate internal fixation for basilar invagination complicated with syringomyelia can not only reduce the odontoid to a physical position, but also decrease the syringomyelia size, which can relieve the clinical symptoms, but its long-term efficacy needs further observation.