一期前后联合入路治疗上颈椎畸形

Anterior Posterior Combined Approach for the Surgical Treatment of Basilar Invagination

回顾9例因颅底凹陷症合并其它畸形在我科接受一期经口咽齿状突切除、后路枕骨大孔减压、寰枢椎或枕颈融合术治疗的临床资料,观察该术式对脊髓功能、枕颈部稳定性的影响及其临床疗效。本组术前诊断均为颅底凹陷症合并邻近结构畸形。所有患者均接受前后联合入路手术。末次随访JOA评分15±1分。影像学检查示齿状突残留基底部均位于钱氏线以下,脊髓减压充分,寰枢间、枕颈间植骨均获坚强融合,融合时间平均3.9±1.1个月。因此一期前后路联合手术治疗颅底凹陷症,脊髓减压充分,重建稳定性后骨融合好,治疗效果满意。

To summarize the clinical effect of one stage anterior posterior combined approach for the surgical treatment of basilar invagination. Since January 2004 to January 2006,9 cases with basilar invagination were treated with this operation. The effects on the spinal cord function ,stability and the clinical effects were reviewed. Bony unions were obtained in both with occipito-cervical fusion and atlantoaxis arthrodesis. Therefore, transoralphaynx odontoid process excision and occipital foramen magnum decompression and occipital cervical fusion or atlanto--axis arthrodesis can decompress the spinal cord effectively and obtain the stability of cervical spine .