颈枕融合术治疗复杂颅颈交界区畸形的疗效分析

Curative effect of cervio-occipital fusion on complex craniocervical junction malformation

目的探讨颈枕融合术治疗复杂颅颈交界区畸形的疗效。方法回顾性分析2012年2月至2018年2月武汉大学人民医院神经外科行枕颈融合术治疗的23例复杂颅颈交界区畸形的临床资料。3例行经口齿状突切除+后路枕颈固定融合术,20例行寰枢椎复位+后颅窝减压+后路枕颈固定融合术。结果术后2周齿状突与钱氏线距离、日本骨科协会评分、延髓-脊髓角、寰齿间距较术前均明显改善(P<0.05)。23例术后随访半年至5年,均未出现关节松动,内固定及植骨均较为牢靠;复查头颈部MRI均示脊髓压迫明显减轻,寰枕关节复位良好,内固定固定良好。结论颈枕融合术治疗复杂颅颈交界区畸形是一种安全且有效的方式。

Objective To investigate the curative effect of cervico-occipital fusion on complex craniocervical junction malformation（CCJM）. Methods Of 23 patients with CCJM undergoing cervico-occipital fusion in our department from February, 2012 to February, 2018, 3 were treated by odontoid resection and posterior cervico-occipital fixation and 20 were treated by atlantoaxial reposition, posterior cranial fossa decompression and posterior cervico-occipital fixation. The efficacy and safety of the surgery were analyzed. Results The distance between odontoid and Chamberlain line, the Japanese Orthopedic Association（JOA） score, the cervicomedullary angle, and the atlantoodontoid interval were significantly improved after the operation compared to those before the operation（P〈0.05）. These 23 patients were followed up from a half to 5 years after the operation. No joint loosening were observed and the internal fixation or bone graft were reliable in all the patients. Conclusion Cervico-occipital fusion is a safe and effective surgical method to treat CCJM.