应用宣武枕颈复位内固定系统一期后路手术治疗颅底凹陷寰枢椎脱位临床报告

Reduction of the atlantoaxial dislocation associated with basilar invagination through single-stage posterior approach:using Xuanwu occipital-cervical reduction surgical suite

目的探讨使用宣武枕颈复位内固定系统,通过单纯后路方式松解前方软组织,复位颅底凹陷寰枢椎脱位的临床效果。方法回顾性分析首都医科大学宣武医院神经外科和河北医科大学第二医院神经外科2018年1—6月诊治的37例颅底凹陷寰枢椎脱位患者的病例资料,其中男性15例,女性22例,年龄(42.3±12.3)岁(范围:18~69岁)。所有患者均合并不同程度寰枕融合,颈椎分节不良等先天性骨发育异常。术中通过后路寰枢椎关节间撑开松解前方软组织,在侧方关节间植入高度适宜的融合器,并利用悬梁臂技术进行复位和融合。采用日本骨科协会(JOA)评分评估患者临床症状,影像学指标主要包括寰齿间距,齿状突尖距钱氏线的距离,斜坡枢椎角及脊髓空洞长度。采用配对样本t检验比较术前、术后的JOA评分和影像学指标。结果37例患者的JOA评分由术前的10.5分增至术后1年的14.4分(t=14.3,P=0.00);34例患者在术后获得了寰枢椎在水平和垂直方向的完全复位,平均斜坡枢椎角由术前的(118.0±6.5)°增至术后的(143.7±5.0)°(t=6.2,P=0.00)。33例患者术前合并脊髓空洞,24例术后1周出现脊髓空洞缩小,共31例在术后6个月发现脊髓空洞缩小。28例患者术后6个月出现了骨性融合,全部患者在术后12个月出现骨性融合。1例患者术后短暂头晕,诊断为单侧椎动脉闭塞,2周后症状消失。2例患者术后颈部疼痛,1个月后症状消失。无植入物失败、融合器沉降及感染等并发症。结论使用宣武枕颈复位内固定系统一期后路手术治疗颅底凹陷寰枢椎脱位安全、有效,融合器置入和悬臂技术能够在多数病例中实现满意复位。

Objective To examine the effect of posterior reduction in atlantoaxial dislocation(AAD)associated with basilar invagination(BI)using Xuanwu occipital-cervical fusion system in single stage.Methods Thirty-seven AAD accompanied with BI cases treated at Department of Neurosurgery,Xuanwu Hospital,Capital Medical Universiy and the Second Hospital of Hebei Medical University were retrospective analyzed.There were 15 males and 22 females with age of(42.3±12.3)years(range:18-69 years).All the cases had congenital osseous abnormalities,such as assimilation of atlas and abnormal cervical fusion.Anterior tissue was released through posterior route followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique.The clinical results were evaluated using Japanese Orthopedic Association scale(JOA)and the main radiological measurements including anterior atlantodental interval(ADI),the distance of odontoid tip above Chamberlain line,clivus-canal angle(CCA)and the length of syrinx were collected.The preoperative and postoperative JOA score and radiological measurements were compared by paired t-test.Results The mean JOA score of the patients increased from 10.5 to 14.4 at the one-year follow-up(t=14.3,P=0.00).Complete reduction of AAD and BI was achieved in 34 patients.The mean clivus-canal angle improved from(118.0±6.5)degrees preoperative to(143.7±5.0)degrees postoperative(t=6.2,P=0.00).Shrinkage of the syrinx was observed 1 week after surgery in 24 patients,and 6 months in 31 patients.Twenty-eight patients achieved bone fusion 6 months after surgery.All the patients achieved bone fusion 12 months after surgery.One-side vertebral artery occlusion was diagnosed in 1 case postoperatively for transient dizziness,and relieved in 2 weeks.Two patients developed moderate neck pain after surgery,and relieved in 1 month.No implant failure,spacer subsidence or infection was observed.Conclusions The treatment of AAD associated with BI using Xuanwu occipital-cervical fusion system from posterior approach in single stage is effective and safe.Cage implantation intraarticularly and fixation with cantilever technique achieve complete reduction in most cases.