术前牵引后路枕颈复位固定融合治疗颅底凹陷症并可复性寰枢椎脱位

Preoperative traction followed by posterior occipitocervical reduction and fusion for basilar invagination combined with reducible atlantoaxial dislocation

中文关键词:  颅底凹陷症  寰枢椎脱位  颅骨牵引  复位  枕颈融合

英文关键词:Basilar invagination  Atlantoaxial dislocation  Skull traction  Reduction  Occipitocervical fusion

中文摘要:

  【摘要】 目的：评价术前牵引后路枕颈复位固定融合治疗颅底凹陷症并可复性寰枢椎脱位的疗效。方法：2004年3月~2012年6月共收治12例颅底凹陷症并可复性寰枢椎脱位患者，男9例，女3例，年龄8~63岁，平均 37.5±18.7岁。术前单纯表现为颈肩痛3例、头晕1例，余均存在脊髓损伤症状。术前JOA评分5~12分，平均8.3±2.1分；颈髓延髓角108°~121°，平均108.9°±8.1°。入院后均行颅骨牵引7~28d，平均14.7±8.1d。当齿状突满意复位后，维持牵引3~5d，行后路枕颈复位固定并取髂骨植骨融合术，术后颈托外固定3个月。结果：齿状突均有较好的复位，无术中、术后并发症。11例患者获得随访，随访时间8~98个月，平均43.0±19.6个月，固定满意并坚固融合，融合时间为3~6个月，平均4.3个月。所有患者神经功能恢复良好，末次随访JOA评分为8~17分，平均15.1±1.6分，较术前明显提高，差异有统计学意义（P<0.05），神经功能改善率为78.2%。末次随访颈髓延髓角为125°~141°，平均133.3°±9.3°，较术前明显增加，差异有统计学意义（P<0.05）。末次随访时手术疗效按Epstein标准评定，优6例，良4例，可1例。结论：术前牵引后路枕颈复位固定融合是治疗颅底凹陷症并可复性寰枢椎脱位的简单、安全、有效方法。

英文摘要:

  【Abstract】 Objectives: To evaluate the efficacy of preoperative skull traction and posterior occipitocervical reduction and fusion for basilar invagination combined with reducible atlantoaxial dislocation. Methods: Twelve patients(9 males and 3 females) with basilar invagination combined with reducible atlantoaxial dislocation were treated surgically from March 2004 to June 2012. The mean age was 37.5±18.7 years old(ranging from 8 to 63 years old). The clinical manifestation showed cervicobrachialgia in 3 patients, dizziness in 1 patient, and the other patients all had obviously neurological deficits. The mean JOA score before the operation was 8.3±2.1(5-12) points. The mean preoperative cervicomedullary angle was 108.9°±8.1°(108°-121°). All the patients underwent skull traction for 7 to 28 days(average, 14.7±8.1d) before surgery. Once the odontoid process got good reduction, the skull traction continued for 3 to 5 days, followed by posterior instrumentation and occipitocervical fusion with screw- rod system. After operation, all patients wore hard collar fixation for 3 months. Results: All patients showed good clinical result due to the reduction of odontoid process. No complication happened during and after the surgery. 11 patients were followed up successfully. The average follow-up time was 43.0±19.6 months(ranging from 8-98 months). No internal instrument failure was noted. All patients had good fusion with an average fusion time of 4.3 months(ranging from 3-6 months). The neurological deficit recovered well. The mean JOA score at last follow-up was 15.1±1.6 points(ranging from 8-17 points), which significantly increased compared with that before surgery(P<0.05).The recovering rate of neurological function was 78.2%. The mean cervicomedullary angle at the last follow-up was 133.3°±9.3°(ranging from 125°-141°), which significantly increased compared with that before surgery(P<0.05). The evaluation of operative effects at the last follow-up was: 6 patients achieved good, 4 improved, 1 better based on Epstein standards. Conclusions: Preoperative skull traction and posterior occipitocervical reduction and fusion is safe, simple and effective for basilar invagination combined with reducible atlantoaxial dislocation.