计算机导航辅助下颅颈交界区畸形的内固定治疗

Internal fixation treatment for craniocervical junction malformation under computer-assisted navigation

目的探讨计算机导航在颅颈交界区畸形内固定治疗中的应用价值。方法回顾性分析25例颅颈交界区畸形的病例资料,均在计算机导航辅助下行后路寰枢椎钉棒内固定治疗。术后所有病例随访至少12个月,同时采用日本骨科协会(JOA)脊髓功能评分对病人神经功能进行评估。结果术中导航辅助下行寰椎侧块、枢椎椎弓根螺钉固定15例,经寰枢关节螺钉固定6例,经寰枢关节螺钉联合Brooks技术固定4例;所有病人术中予以植骨融合。末次随访JOA评分由术前的(9.25±2.01)分提高至(14.36±1.97)分,差异具有统计学意义(P<0.05)。所有病人螺钉置入位置满意,未发生椎动脉及神经损伤等并发症。结论计算机辅助导航为术者实施颅颈交界区畸形内固定手术提供重要帮助,在提高术中螺钉置入准确性、减少手术损伤、降低手术并发症等方面有巨大潜力。

Objective To explore the application value of computer-assisted navigation in internal fixation of craniocervical junction malformation. Methods Clinical data of 25 patients with craniocervical junction malformation were analyzed retrospectively. All patients received internal fixation procedures under computer-assisted navigation and were followed up for at least 12 months. Japanese Orthopedic Association（JOA） scores were used to assess the patients＇ neurological function. Results C1 lateral mass and C2 pedicle screw fixation were performed in 15 patients, C1 and C2 transarticular screw fixation in 6 and transarticular screws combined with Brooks technique in 4. Bone graft fusion was performed in all the patients. JOA scores increased from 9.25 ± 2.01 preoperatively to 14.36 ± 1.97 at the last follow-up, significant differences was found between them（P〈0.05）. The screw placement was satisfactory in all the patients with no vascular or neural complications. Conclusion Computer-assisted navigation provides a great help for neurosurgeons in surgical treatment of craniocervical junction malformation, and has great potential in improving the screw placement accuracy, reducing operational damage and surgical complications.