颅底凹陷畸形合并寰枢脱位的外科治疗

Surgical treatment of basilar impression with atlantoaxial dislocation.

目的 探讨颅底凹陷畸形合并寰枢脱位的外科治疗方法。方法 根据其临床表现和影像学特征 ,将 85例颅底凹陷畸形合并寰枢脱位的患者分为A、B组 ,A组行后方入路枕下减压术和 /或枕颈植骨融合内固定术 ,B组行后外侧入路枕下减压加齿状突切除术和枕颈植骨融合术。结果 两组病例疗效明显 ,A组总有效率 87 5 % ,显效率 3 1 2 %。B组总有效率 81 1% ,显效率 2 4 5 % ,病死率 3 8%。结论 后方入路枕下减压术后外侧入路枕下减压加齿状突切除术并枕颈植骨融合术皆是治疗颅底凹陷畸形合并寰枢脱位的有效方法 。

Objective To investigate the surgical treatment of basilar impression malformation with atlantoaxial dislocation.Methods According to their clinical presentations and imaging characteristic,85 cases who suffered from basilar impression with atlantoaxial dislocation were divied into two groups.Patients in group A received posterior decompression and/or iliac bone graft fusion and internal fixation by the suboccipital approach.Patients in group B received posterior decompression and odontectomy and iliac bone graft fusion and internal fixation by the transoccipitocervical posterolateral approach.Results All patients showed favorable outcome.Effective rate of group A was 87.5% and remarkable effective rate was 31.2%.Effective rate of group B was 81.1% and remarkable effective rate was 24.5%.Conclusion Posterior decompression by the suboccipital approach and posterior decompression and odontectomy and iliac bone graft fusion and internal fixation by the transoccipitocervical posterolateral approach are the effective surgical methods to treat basilar impression with atlantoaxial dislocation,but they have defferent indications.