枕下减压枕颈融合在先天性颅颈交界畸形中的应用

Application of Occipital-Cervical Fusion and Sub-Occipital Decompression in Congenital Occipital-Vertebral Junction Malformation

目的探讨后路枕下减压硬脑脊膜减张缝合和枕颈融合术对先天性颅颈交界畸形的治疗作用.方法自2002年10月至2009年4月昆明医学院第二附属医院神经外科收治颅颈交界畸形患者53例,选择其中复杂畸形(指chiari畸形合并扁平颅底、环枢椎脱位或环枕融合等)且适于行后路减压枕颈融合的患者12例(男7例,女5例),后正中直切口完成后路枕骨大孔周围减压(约3.5 cm×2.5 cm)、环椎后弓中线两侧减压(约2.0 cm)、人工硬脑膜减张缝合硬脑脊膜、在C-形臂X线辅助下利用CerviFix-颈椎后路杆固定系统完成枕颈融合.分别于术后半年、1 a及2 a完成随访.按Symon和Lavender临床标准,症状改善一级即为有效.结果 12例手术均获得成功,术中损伤椎动脉1例,以适中的力量加明胶海绵压迫后用骨蜡封闭,出血停止,术后颈托固定3～6个月,术后复查X线片,提示固定效果可靠,固定材料与枕颈部吻合良好.术后随访,除1例重症患者行走困难无明显改善外,其余所有患者症状均获得不同程度改善,临床总有效率为92%.结论应用CerviFix-颈椎后路杆固定系统实现枕颈融合,同时使用枕下减压是治疗先天性颅颈交界畸形安全有效的方法.

Objective To determine the therapeutic effects of occipital-cervical fusion using Cervifix internal fixation system and sub-occipital decompression on congenital occipital-vertebral junction malformation.Methods From October 2002 to April 2009,fifty three patients with occipital-vertebral junction malformation were admitted to our hospital.Among these patients,we selected 12 patients（7 male and 5 femal）with complicated malformations（chiari malformation with platybasia,articulation atlantoaxial semiluxation,or atlan-occipital fusion）who were suitable to receive occipital-cervical fusion.All patients were treated by surgical treatment：about 2.5 cm×3.5 cm bone plate were removed surrounding foramen magnum,2.0cm bone among the midpoint of posterior arch of atlas were decompressed,relaxation suture to dura were finished with artifical cerebral dura mater,occipital-cervical fusion was accomplished with Cervifix internal fixation system under X-ray during the operation.The patients were followed up for half a year,one year and two years after operation.According to Symon and Lavender standard,the effectiveness was that the symptoms were improved to grade I.Results All of 12 patients got successful operation,one patient＇s vertebral artery was injuried and bleeding was stopped by oppression with gelatin sponge and bone wax,cervical gear was used to patients for 3-6 months.X-ray picture of postoperative review showed that the result of immobilization was reliable and the inosculation among Cervifix internal fixation system and occipital bone and cervical vertebrae was satisfactory.All the patients were followed up after operation,and their clinical symptoms had been improved evidently except that the ability of locomotion was not improved in one patient,the total clinical effective rate was 92%.Conclusion To congenital occipital-vertebral junction malformation,it is an effective and safe operation that including occipital-cervical fusion using Cervifix internal fixation system and suboccipital decompression.