枕颈融合联合枕下减压术治疗枕颈畸形并脊髓损伤

Treatment of occipital-cervical deformity and spinal cord injury with foramen magnum decompression combined with occipital-cervical fusion

目的探讨枕颈融合联合枕下减压内固定术治疗枕颈畸形并脊髓损伤的临床疗效及安全性。方法选择郑州大学第一附属医院2011年7月至2014年7月收治的38例枕颈畸形并脊髓损伤患者作为研究对象,男22例,女16例,年龄16~57（38.2±12.1）岁,入院后均行枕颈融合联合枕下减压植骨融合钛板内固定术。通过随访对术前、术后JOA评分进行对比,评估患者神经功能改善情况。根据术后随访影像学资料评价椎管减压、植骨融合等情况。结果所有病例均获随访,平均15.6个月。术中未出现脊髓、椎动脉损伤等严重并发症。术后螺钉位置良好,无松动、断钉,均呈骨性愈合。所有患者神经功能恢复良好,JOA评分：术前5~12（7.1±1.8）分,术后12个月8~17（14.9±1.6）分,差异有统计学意义（P〈0.05）。结论枕颈融合联合枕下减压内固定术是治疗枕颈畸形并脊髓损伤的简单、安全、有效方法,值得临床推广。

Objective To investigate the clinical efficacy and safety of foramen magnum decompression combined with occipital- cervical fusion for the treatment of occipital- cervical deformity and spinal cord injury. Methods 38 patients with occipital- cervical deformity and spinal cord injury from July of 2011 to July of 2014 were selected as the research objects,including 22 males and 16 females,aged 16 ~ 57（ 38. 2 ± 12. 1） years old. All the patients were treated with foramen magnum decompression combined with occipital- cervical fusion with internal fixation. The improvement of neurological function was evaluated by the comparison of preoperative JOA scores and postoperative JOA scores. The spinal canal decompression and bone graft fusion were monitored by radiology or computed tomography. Results All cases were followed up for an average of 15. 6 months.There was no serious complication such as spinal cord and vertebral artery injury during operation. The screws were in good position,no loosening or broken screws. All of the screws were in the healing of bone. The spinal function got improved in all patients,the preoperative scores of JOA were 5 ~ 12（ 7. 1 ± 1. 8） scores,and the JOA scores of postoperative 12 months were 8 ~ 17（ 14. 9 ± 1. 6） scores. There was a statistically significant difference in JOA scores between pre- operation and post- operation（ P〈0. 05）. Conclusion Foramen magnum decompression and occipital- cervical fusion with internal fixation is safe,simple and effective for occipital- cervical deformity and spinal cord injury,worthy of clinical promotion.