后路寰枢关节松解治疗不稳定型颅颈交界区畸形的疗效分析

Efficacy of posterior atlantoaxial joint release in treating craniovertebral junction deformity combined with atlantoaxial instability

目的探讨后路寰枢关节松解融合内固定手术治疗不稳定型颅颈交界区畸形伴难复性寰枢椎脱位的效果。方法对我院在2015年1月-2018年12月行后路寰枢关节松解复位内固定手术治疗的31例不稳定型颅颈交界区畸形患者进行回顾性分析,通过对比手术前后的日本骨科协会(JOA)评分、延髓脊髓角度(CMA)、寰齿间距(ADI)值及齿状突超过钱氏线的距离,分别评估患者术后症状的改善情况和脊髓受压情况及寰枢椎水平、垂直脱位情况。结果平均手术时间(168.38±38.21)min,平均术中出血量(147.09±59.84)mL,平均住院时间(9.54±2.81)d;术中未出现椎动脉、脊髓损伤等严重并发症。术后6 d时患者的JOA、ADI、齿状突超过钱氏线的距离、CMA分别为(11.94±1.37)分、(2.72±1.08)mm、(3.03±0.78)mm、(145.35±8.00)°,与术前的(9.94±1.26)分、(4.96±1.60)mm、(6.89±1.36)mm、(122.16±9.58)°相比,均有明显改善,差异具有统计学意义(P<0.001)。经过6~25(14.90±6.70)个月随访,未见内固定松动、移位情况,末次随访时患者的JOA评分增加到(13.16±1.19)分,与术前相比差异具有统计学意义(P<0.001)。结论经后路寰枢关节松解手术治疗不稳定型颅颈交界区畸形伴难复性寰枢椎脱位安全有效。

Objective To evaluate the curative effect of posterior atlantoaxial joint release and internal fixation in treating unstable craniocervical junction malformation(UCVJM).Methods This study retrospectively enrolled 31 patients with UCVJM,who received posterior atlantoaxial joint release and internal fixation between January 2015 and December 2018.The pre-and postoperative changes of the Japanese Orthopaedic Association(JOA)scores,the cervicomedullary angle(CMA),the atlantodental interval(ADI)and the height above the Chamberlain line of the odontoid(H)were traced to evaluate whether clinical symptoms,compression of spinal cord,horizontal and vertical dislocation of atlantoaxial were improved postoperatively.Results The average operation duration,bleeding during operation and the average days of hospitalization were(168.38±38.21)min,(147.09±59.84)mL,and(9.54±2.81)days,respectively.None of the patients had vertebral artery or spinal cord injury during operation.JOA score,ADI,H,and CMA were(11.94±1.37)points,(2.72±1.08)mm,(3.03±0.78)mm,and(145.35±8.00)°respectively on the6 th days after operation compared with the preoperative(9.94±1.26)points,(4.96±1.60)mm,(6.89±1.36)mm and(122.16±9.58)°,with statistical differences,which indicated all indexes were improved(all P<0.001).During 6-25 months’follow-up,there was no internal fixation looseness or displacement and JOA score was increased to(13.16±1.19)for all the patients in the last follow-up(all P<0.001).Conclusion The posterior atlantoaxial joint release combined with internal fixation is safe and effective for patients with UCVJM.