经后路寰枢椎侧块螺钉固定联合枕下减压治疗Arnold-Chiari畸形合并寰枢关节脱位

POSTERIOR ATLANTOAXIAL LATERAL MASS SCREW FIXATION AND SUBOC CIPITAL DEC OMPRESSION FOR TREATMENT OF Arnol d-C hiari MALFORMATION ASSOCIATED WITH ATLANTOAXIAL DISLOCATION

目的 探讨经后路寰枢椎侧块螺钉固定联合枕下减压治疗Arnold-Chiari畸形合并寰枢关节脱位的疗效。方法 2012年9月-2015年11月,收治17例Arnold-Chiari畸形合并寰枢关节脱位患者,均行经寰枢椎侧块螺钉固定＋枕下减压扩大硬脑膜修补＋植骨融合术治疗。男10例,女7例;年龄35~65岁,平均51.4岁。病程14个月~15年,平均7.4年。Arnold-Chiari畸形分型：Ⅰ型13例,Ⅱ型3例,Ⅲ~Ⅳ型1例。存在中上颈神经根刺激和压迫症状12例,枕大孔综合征11例,小脑受压症状6例,脊髓空洞症10例。结果 1例术后第3天拔除引流管后出现脑脊液切口漏,腰大池引流7 d后切口愈合良好,脑脊液漏消失。其余患者切口均Ⅰ期愈合,无手术早期并发症发生。患者均获随访,随访时间6个月~2年,平均18.4个月。患者神经功能障碍均有不同程度改善,术后6个月日本骨科协会（JOA）评分为（16.12±1.11）分,较术前的（11.76±2.01）分明显提高,比较差异有统计学意义（t=13.596,P=0.000）;脊髓及延髓受压改善。X线片复查示,术后6个月内植骨均达融合。10例合并脊髓空洞者6个月复查MRI显示3例空洞消失,6例空洞变小,1例无明显变化。结论 寰枢椎侧块螺钉固定联合枕下减压扩大硬脑膜修补术治疗Arnold-Chiari畸形合并寰枢关节脱位可获得良好疗效。

ObjectiveTo evaluate the effectiveness of the posterior atlantoaxial lateral mass screw fixation and suboccipital decompression in the treatment of Arnold-Chiari malformation associated with atlantoaxial joint dislocation. MethodsBetween September 2012 and November 2015, 17 cases of Arnold-Chiari malformation associated with atlantoaxial dislocation were treated by the posterior atlantoaxial lateral mass screw fixation and suboccipital decompression and expansion to repair the dura mater and bone graft fusion. There were 10 males and 7 females, aged 35-65 years （mean, 51.4 years）. The disease duration was 14 months to 15 years with an average of 7.4 years. According to Arnold-Chiari malformation classification, 13 cases were rated as type I, 3 cases as type II, and 1 case as type III-IV. Cervical nerve root stimulation and compression symptoms were observed in 12 cases, occipital foramen syndrome in 11 cases, cerebellar compression symptoms in 6 cases, and syringomyelia in 10 cases. ResultsPrimary healing of incision was obtained in the other patients except 1 patient who had postoperative cerebrospinal fluid leakage after removal of drainage tube at 3 days after operation, which was cured after 7 days. All patients were followed up 6 months to 2 years, with an average of 18.4 months. The neurological dysfunction was improved in different degrees after operation. The Japanese Orthopedic Association （JOA） score was significantly increased to 16.12±1.11 at 6 months from preoperative 11.76±2.01 （t=13.596, P=0.000）; compression of spinal cord and medulla was improved. X-ray examination showed bone graft fusion at 6 months after operation. In 10 patients with spinal cord cavity, MRI showed empty disappearance in 3 cases, empty cavity lessening in 6 cases, and no obvious change in 1 case at 6 months. ConclusionAtlantoaxial lateral mass screw fixation and suboccipital decompression and expansion to repair the dura mater can obtain good effectiveness in the treatment of Arnold Chiari malformation associated with atlantoaxial transarticular dislocation.