先天性颅底凹陷症的细化分型及临床分析(附139例报告)

Detailed classification and clinical analysis of congenital basilar invagination: A report of 139 cases

目的探讨先天性颅底凹陷症的细化分型及临床特征。方法回顾性分析139例行手术治疗的颅底凹陷症病人的临床资料,均行颈椎MRI、MRI-Cine及颅颈交界区三维CT重建检查,在Goel分型基础上根据是否合并脊髓空洞症将其进一步分为4型:BIa+0型31例,BIa+S型45例,BIb+0型21例,BIb+S型42例。采用日本骨科协会(JOA)评分评价手术疗效。结果随访6~24个月,平均12个月。术后2周、1年JOA评分平均改善率分别为:BIa+0型30.78%、58.29%,BIa+S型35.09%、60.64%,BIb+0型36.57%、62.73%,BIb+S型31.92%、57.48%。4型病人中,术后2周、1年的JOA评分均较术前明显升高(P <0.01)。结论颈椎MRI、MRI-Cine及颅颈交界区三维CT重建检查可清晰显示颅颈交界区病变及解剖结构,细化分型可准确反映复杂先天性颅底凹陷症的临床特征,为手术创造良好条件,有很好的应用价值。

Objective To investigate the detailed classification and clinical characteristics of congenital basilar invagination. Methods Clinical data of 139 patients with congenital basilar invagination were analyzed retrospectively. Cervical vertebra MRI, MRI-Cine and three-dimensional CT reconstruction of cranio-cervical junction were performed in all the patients. On the basis of Goel classification,the patients were further divided into four categories: BIa+0 type in 31 patients, BIa+S type in 45, BIb+0 type in 21 and BIb+S type in42 according to whether accompany with syringomelia. The clinical effects were analyzed by Japanese orthopaedic association(JOA)scores. Results The mean follow-up period was 12 months, ranged from 6 to 24 months. The improvement rate of JOA scores 2 weeks and 1 year after operation were as follows respectively: 30.78% and 58.29% in BIa+0 type, 35.09% and 60.64% in BIa+S type,36.57% and 62.73% in BIb+0 type and 31.92% and 57.48% in BIb+S type. The JOA scores 2 weeks and 1 year after surgery were significantly higher than those before surgery in all the patients(P < 0.01). Conclusions Cervical vertebra MRI, MRI-Cine and three-dimensional CT reconstruction can clearly show the lesions and anatomical structure of cranio-cervical junction, and the detailed classification can accurately reflect the clinical features of complicated congenital basilar invagination, has better applicaltion values.