改良后路枕颈融合术治疗儿童和青少年寰椎枕骨化并寰枢关节脱位的疗效分析

Modified posterior occipital fusion for treatment of atlantooccipital and atlantoaxial dislocation in children and adolescents

目的观察改良后路枕颈融合术治疗儿童和青少年寰椎枕骨化并寰枢关节脱位的临床疗效。方法回顾性分析贵州省人民医院神经外科自2013年11月至2018年4月行改良后路枕颈融合术治疗的11例儿童和青少年寰椎枕骨化并寰枢关节脱位患者的临床资料。手术前后采用日本骨科协会(JOA)评分评价患者颈椎功能;通过患者CT图片测量寰椎齿状突间距(ADI),评价脱位复位情况;通过患者MRI图片测量延髓颈髓角(CMA),评价脊髓受压程度。结果11例患者临床症状均有不同程度改善,术后均无并发症发生。与手术前比较,患者手术后JOA评分显著提高(15.0±1.0vs.12.2±1.6),ADI明显缩小,CMA明显增大,差异均有统计学意义(P<0.05)。结论采用改良后路枕颈融合术治疗儿童和青少年寰椎枕骨化并寰枢关节脱位安全有效。

Objective To study the clinical efficacy of modified posterior occipital fusion in atlantooccipital and atlantoaxial dislocation in children and adolescents. Methods The clinical data of 11 children or adolescents with atlantooccipital and atlantoaxial dislocation, admitted to and accepted modified posterior occipital fusion in our hospital from November 2013 to March 2018, were retrospectively analyzed. Before and after the surgery, Japanese orthopedic association (JOA) scale was used to evaluate the cervical vertebral function of the patients, the atlanto-dens interval (ADI) was measured by CT images to evaluate the dislocation and reduction of joints, and the medulla bulbar cervical medulla angle (CMA) of the patients was measured by MR imaging to evaluate the degrees of spinal cord compression. Results The clinical symptoms of 11 patients improved in different degrees. No postoperative complications occurred. JOA scale scores after operation were significantly higher than those before operation (15.0±1.0 vs. 12.2±1.6). Significantly decreased of ADI and significantly increased CMA after operation were noted as compared with those before operation (P<0.05). Conclusion Modified posterior occipital fusion is safe and effective for treatment of atlantooccipital and atlantoaxial dislocation in children and adolescents.