枕颈部畸形伴脊髓损伤的外科治疗策略

Surgical strategy for occipitocervical deformities concomitance spinal cord injury

目的探讨枕颈部畸形伴脊髓损伤患者的外科治疗。方法回顾性研究28例枕颈部畸形伴脊髓损伤患者的临床资料,仔细分析患者的影像学资料,明确枕颈部畸形的种类、颈脊髓受压方向,选择合适的手术入路。结果 28例均接受手术治疗,其中8例行经口咽入路减压加后路减压植骨枕颈融合内固定术,20例行后路减压植骨枕颈融合内固定术;术中未发生感染、脑脊液漏、椎动脉损伤等并发症;术后Frankel B级2例恢复至C级,C级6例恢复至D级,D级15例恢复至E级、另外3例无变化。结论枕颈部畸形伴脊髓损伤的患者,术前仔细分析影像学资料,合理选择手术入路,彻底解除压迫、重建枕颈部的稳定,可以取得良好的临床疗效。

Objective To investigate the surgical treatment for occipitocervical deformities concomitance spinal cord injury. Methods The clinical data of 28 patients with occipitocervical deformities concomitance spinal cord injury were reviewed and analyzed. The imaging was analyzed to identify characters of malformation and the direction of cervical spinal cord compression. Then the appropriate surgical approach was selected. Results All the 28 cases received surgical treatment, and 8 of them were treated with transoral approach densectomy decompression and posterior occipitocervical decompression and fusion in the mean time, while the other 20 cases were treated with occipitocervieal decompression and fusion. There were no complications such as infection, vertebra artery injury and leakage of cerebrospinal fluid. According to Frankel classification, 2 cases of B recovered up to grade C, 6 cases of C recovered up to grade D. In 18 cases of D, 15 cases recovered up to grade E, the others no neuralogic deterioration. Conclusion For the patients with occipitoeervieal deformities concomitance spinal cord injury, imaging data should be analyzed carefully preoperative and the appropriate surgical approach should be chosen. Satisfactory clinical efficacy will be obtained by decompression thoroughly and re-establish the occipitocervieal stabilization.