复杂寰枕畸形的手术减压和内固定选择

Selection of the Method of Operative Decompression and Internal Fixation for Complicated Occipitocervical Malformation

目的:探讨复杂寰枕畸形的外科手术方法。方法:将90例复杂寰枕畸形的患者根据其临床表现和影像学特征分为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内固定术。结果:两组病例疗效明显,A组总有效率83·3%,显效率16·6%,B组总有效率82·1%,显效率14·1%,死亡率2·6%。结论:复杂寰枕畸形的治疗中手术减压和稳定性重建即植骨融合内固定应该并重,不同寰枕畸形可选用不同的减压和内固定方式。

Objective： To investigate the surgical treatment of complicated occipitocervical malformation. Methods： According to their clinical presentations and imaging characteristics, 90 cases complicated occipitocervical malformations were divided into two groups. Patients in group A received posterior decompression through suboccipital approach and combined with internal fixation and iliac bone graft. Patients in group B received posterior decompression and edontectomy and iliac bone graft through transoccipitocervical posterolateral approach. Results： All patients showed favorable outcome. Effective rate of group A was 83.3 % and remarkable effective rate was 16.6%. Effective rate of group B was 82.1% and remarkable effective rate was 14.1%. Conclusion： Operative decompression with stability reconstruction was important to treat the complicated occipitocervical malformations. Different kinds of complicated occipitocervical malformations should choose different kinds of the methods of decompression and internal fixation.