枕颈融合固定在颅颈部畸形手术中的应用

Occipitocervical fusion and fixation in malformation of craniocervical junction surgery

目的·研究枕颈融合固定在颅颈交界处畸形治疗中的应用。方法·在诱发电位监测下对36例颅颈交界处畸形行枕颈部减压,术中采用Vertex枕骨钉–椎板钩系统固定16例,Vertex螺钉–钛棒系统固定11例,Mountaineer OCT系统固定9例。术后随访2~12年(平均7年),依据颈椎JOA评分表对术后患者进行评分。结果·全部病例获得随访。与术前比较,影像学资料显示术后9个月植骨融合率达100%。无内固定棒钉断裂及脱钩现象。JOA评分结果显示:治愈24例(66.7%),显效4例(11.1%),有效8例(22.2%),无效0例。结论·枕颈固定融合有助于恢复颅颈交界区的稳定性。术前完善的影像学资料、明确的手术指征、合适的术式及内固定材料,是患者获得良好预后的关键。

Objective To study the application of occipitocervical fusion and fixation in malformation of craniocervical junction surgery. Methods Thirty-six consecutive patients with craniocervical junction malformation were decompressed under evoked-potential monitoring. Sixteen patients were treated with posterior occipitocervical fusion and fixation using Vertex screw-hook system, and ll using Vertex screw-rod system, other patients using Mountaineer OCT spinal system. All patients were followed up for 2 to 12 years （mean 7 years）. The recovery rate was analysed based on the scoring system of the Japanese Orthopaedic Association （JOA）. Results AII the patients were followed up. A stable bony fusion according to radiological criteria was achieved in all cases. There was no implant broken and dislocation. The improvement rate according to JOA scoring system were evaluated. Twenty-four cases （66.7%） got cured; 4 cases （11.1%） had remarkable effects; 8 cases （22.2%） were effective; none was ineffective. Conclusion Occipitocervical stabilizations hope to be restored through occipitocervical fusion and fixation. Good results can be obtained in most patients with complete radiological data, proper surgery indication, suitable surgical modality and internal fixation materials.