经口前路复位内固定技术治疗儿童型颅底凹陷症

Treatment of pediatric basilar invagination by anterior transoral reduction and fixation

目的：探讨经口前路复位内固定技术治疗儿童型颅底凹陷症的方法和疗效。方法对2010年3月至2013年3月广州军区广州总医院收治的5例儿童型颅底凹陷症患者施行经口前路复位内固定手术。通过MRI影像学图片测量颈髓角（CMA），评价术后脊髓压迫恢复情况；根据日本骨科学会（JOA）评分评价脊髓功能；运用CT扫描重建技术观察植骨融合情况。结果5例患儿均顺利施术，手术时间2.5～3.5 h，平均手术时间（2.7±0.6）h；术中出血量40～100 mL，平均出血量55 mL。术后患儿脊髓压迫解除，CMA从术前的（135±12）°恢复到术后3个月的（163±11）°（P＜0.05）；患者脊髓功能改善，JOA评分自术前的（8.3±1.2）分恢复至术后3个月（15.7±1.3）分（P＜0.05）。随访12～28个月，平均随访时间18.5个月。术后3～6个月所有患儿均获植骨融合，随访期间未出现切口感染等严重并发症。结论经口前路复位内固定技术是治疗儿童型颅底凹陷症的有效方法。

Objective To investigate anterior transoral reduction and fixation approaches and therapeutic effects for pediatric basilar invagination. Methods From March 2010 to March 2013, 5 cases of pediatric patients with basiliar invagination were surgically treated by anterior transoral reduction and fixation in Guangzhou General Hospital of Guangzhou Military Command. Cervical medullary angle （CMA） was measured for evaluating the decompression of medulla through MRI images, Japanese Orthopaedic Association （JOA） scoring system was used to evaluate the function of spinal cord; CT scanning and reconstruction was performed to observe bone graft fusion. Results All 5 patients underwent operations successfully. The operative time was 2.5-3.5 h, with the average of（2.7 ± 0.6）h; The estimate blood loss was 40-100 mL, with the average of 55 mL. Spinal decompression was accomplished and CMA improved from preoperative （135 ± 12）° to postoperative （163 ± 11）° （P 〈0.05）; Function of spinal cord improved, and JOA scores increased from （8.3 ± 1.2）＆amp;nbsp;preoperatively to （15.7 ± 1.3） postoperatively （P 〈0.05） . All children were followed up for 12 to 28 months with the average of 18.5 months. Bony fusion were found in 3 to 6 months after operation. During the follow-up, no serious complications such as surgical site infection had happened. Conclusion Anterior transoral reduction and fixation is an effective method for pediatric basilar invagination.