颅底凹陷症分型的再研究及临床意义

Restudy the Classification of Basilar Invagination and Clinical Significance

目的回顾性分析颅底凹陷症患者的临床表现及影像学特点,对颅底凹陷症的分型进行再研究,提出新的分型及其在临床诊疗中指导意义。方法自2010年7月~2015年11月共收治颅底凹陷症患者36例,男16例,女20例;年龄18~59岁,平均38.5岁。记录其临床症状和体征,摄颈椎正、侧位及动力位X线片,并行CT和MRI检查。其中合并寰枕融合21例,C2,3融合16例,脊髓空洞18例,寰枢椎脱位26例,寰枢椎非脱位10例。根据有无合并寰枢椎脱位,将36例颅底凹陷症分为Ⅰ型（脱位型）26例和Ⅱ型（非脱位型）10例。Ⅰ型根据牵引或颈椎过伸过曲能否复位分为A,B两个亚型,ⅠA型为牵引或过伸过曲可复位型,ⅠB型为不可复位型。ⅠA型行口咽前路齿状突切除松解钢板复位植骨融合内固定术治疗;ⅠB型行后路椎弓根钉牵引提拉复位内固定植骨融合术;Ⅱ型行后路枕骨大孔周围减压成形术。术后及随访时通过X线片、CT及MRI检查观察减压固定及植骨融合情况。手术前后及末次随访时神经功能按日本骨科协会（JOA）评分进行评定。结果 36例患者随访时间11~37个月,平均17.4个月。植骨于术后7~16个月融合,平均9.8个月。术前JOA评分4~13分,平均8.5分;术后JOA评分为9~16分,平均14.5分,改善率为80.1%,优良率为81.4%.围手术期并发症6例,包括感染1例,脑脊液漏3例,呼吸功能障碍2例。结论根据临床和影像学结果将颅底凹陷症分型进行再研究,分为Ⅰ型（A、B）和Ⅱ型,这一分型方法有益于正确认识不同类型颅底凹陷症的解剖学和临床特点,从而选取合适的手术治疗方法。

Objective To retrospective analysis of the clinical and imaging characteristics of patients with basilar invagination（ BI） and restudy the typing of invagination,then put forward the new classification and significance in clinical practice. Methods From July 2010 to November 2015,36 patients with BI were treated,male 16,female 20cases; the average age was 38. 5 years（ 18 to 59）. Recorded clinical symptoms and signs,and preoperation imaging of camera cervical,lateral and power X-ray,parallel CT and MRI. The merger between 21 cases pillow fusion,16 cases C2-3fusion,18 cases syringomyelia,atlanto-axial dislocation 26 cases of vertebral,atlas posterior atlanto-axial dislocation 10 cases. BI was classified into Type Ⅰ with dislocation（ 26 cases） and Type Ⅱ without dislocation（ 10 cases）. The traction type Ⅰ according to traction or cervical spine flexion can reset into A,B two subtypes,type Ⅰ A was traction or excessive flexion resettable,type Ⅰ B was non-resettable. Type Ⅰ A was treated by row oropharyngeal anterior odontoid resection reset release plate fixation and bone graft fusion treatment; type Ⅰ B was treated by posterior pedicle screw fixation traction pulling reset bone grafting; type Ⅱ was treated by posterior magnum around the hole decompression angioplasty.After decompression and fixation and fusion occurs follow-up by X-ray,CT and MRI observation. Before and after surgery and the last follow-up neurological function according to the Japanese Orthopaedic Association（ JOA） scores were assessed. Results Thirty-six patients were followed up for 11 ~ 37 months,average months were 17. 4. Bone at 7 to 16 months after fusion,an average of 9. 8 months. Preoperative JOA score of 4 to 13 points,an average points were 8. 5; postoperative JOA score was 9 to 16 points,an average points were 8. 5,14. 5,80. 1% improvement rate,good rate of 81.4%. Perioperative complications in 6 cases,including 1 case of infection,cerebrospinal fluid leakage in 3 cases,2 cases of respiratory dysfunction. Conclusion The basilar invagination classification according to clinical and radiographic results of further research into Ⅰ type（ A,B） and Ⅱ. This typing method can correct understanding of anatomy and clinical characteristics of different types of basilar invagination,and select the appropriate surgical treatment.