不同术式治疗颅颈交界区畸形的临床疗效探讨

Analysis on the therapeutic effect of different neurosurgical approaches for cranio-cervical malformation

目的探讨颅颈交界区畸形不同外科处理方式的临床效果。方法分析第四军医大学西京医院神经外科2008年4月至2017年6月手术治疗的690例颅颈交界区畸形患者资料。其中,枕骨钉枢椎椎弓根螺钉复位内固定术治疗390例,寰枢椎椎弓根螺钉复位内固定术治疗210例,单纯后路减压术治疗90例。术前日本整形外科协会(JOA)评分为3~13(平均8.20±4.34)分,术后通过对患者的临床症状、JOA评分和影像学改善情况进行1~14个月随访,分析手术疗效。结果随访期内,术后所有患者的临床症状明显减轻,JOA评分为7~16(平均12.13±3.38)分,较术前分值显著提高(t=-5.976,P=0.002)。术后3 d颈椎CT显示所有患者的螺钉位置良好,寰枢关节脱位完全复位者485例,颈髓MRI显示脊髓形态得到一定程度的改善。术后3月颈椎CT显示骨性融合良好,颈髓MRI显示脊髓空洞消失或明显改善者512例。结论根据患者颅颈交界畸形是否稳定而选择不同术式,可取得良好的临床效果。

Objective The clinical effect of three approaches to cranio-cervical malformation surgery was discussed. Methods Six hundreds and ninety patients with cranio-cervical malformation who accepted operations were included in the study. Pre-operative Japanese Orthopedic Association （JOA） score evaluation of the patients was 3 -13 （average value was 8.20 ±4. 34）. Posterior interoal fixation using occipital screws combined with axis pedicle screws was performed in 390 patients, posterior atlanto-axial pedicle screw reduction and internal fixation was completed in 210 patients. In addition, 90 patients were only treated with surgical removal of arcns posterior atlantis and foramen magnum posterior margin. The therapeutic effect was assessed by past-operative clinical symptoms, JOA score and inraging. Follow-up was obtained for all the patients for a period of 1 - 14 months. Results Clinical symptoms of all the patients were significantly improved after surgery. Post-operative JOA score was 7 - 16 （ average value was 12. 13± 3.38）, which was significantly increased compared to pre-operation （ t = - 5. 976, P = 0.1302）. Moreover, cervical CT scanning showed all the screws were well in position including 485 patients with atlanto-axial luxations totally restored, and MRI showed the spinal cord shape was improved at 3 d after operation. Three dimensional CT scanning showed that the result of occipital/interbody fusion was satisfactory and MRI suggested that 512 syringomyelia cases disappeared or were evidently ameliorated at 3 months following surgery. Condusion The stability of cranio-cervical malformation should be considered as a key factor for the neurosurgical approach choice for a better therapeutic effect.