颅底凹陷型难复性寰枢椎脱位术后齿状突下移与神经功能的关系

Relationship between dentate movement and nerve function after dented skull base refractory atlantoaxial dislocation

目的 研究颅底凹陷型难复性寰枢椎脱位术后齿状突下移与神经功能的关系。方法 选择本院2016年9月~2018年9月收治的30例颅底凹陷型难复性寰枢椎脱位患者作为研究对象,分析其术前和术后6~24个月的颈椎功能障碍指数(neck disability index,NDI)、齿状突与麦氏线距离、Bull角、克劳指数、Boogard角、寰椎后弓与齿状突前缘距离、枕骨斜坡与齿状突后缘夹角、齿状突下移率、ASIA神经功能评分。结果 患者术前和术后6~24个月的NDI指数、齿状突与麦氏线距离、Bull角、克劳指数、Boogard角、寰椎后弓与齿状突前缘距离比较,患者术前和术后24个月的枕骨斜坡与齿状突后缘夹角比较,差异均有统计学有意义(P<0.05)。患者术后6~24个月的齿状突下移率比较,患者术前和术后6~24个月的ASIA神经功能评分比较,差异均有统计学意义(P<0.05)。经Pearson直线相关法分析,术后齿状突下移率与ASIA神经功能评分呈正相关(P<0.05)。结论 颅底凹陷型难复性寰枢椎脱位术后齿状突下移对神经功能有显著影响,临床可通过促进齿状突下移,提高患者的神经功能。

Objective To study the relationship between dentate movement and nerve function after dented skull base refractory atlantoaxial dislocation.Methods Thirty patients with intractable atlantoaxial dislocation of the skull base in our hospital from September 2016 to September 2018 were selected in this research.The neck disability index(NDI),distance between odontoid process and Maxwell line,Bull angle,Crowe index,Boogard angle,distance between posterior arch of atlas and front edge of odontoid process,angle between the occipital slope and posterior edge of odontoid process,the rate of dentate movement,and the ASIA nerve function score were analyzed at preoperation and postoperative 6-24 months.Results NDI,distance between odontoid process and McGregor’s line,Bull angle,Crowe index,Boogard angle,distance between posterior arch of atlas and front edge of odontoid process were compared before operation and 6-24 months after surgery,and the angle between the slope of the occipital bone and the posterior edge of the odontoid process was compared before operation and 24 months after operation,the differences were statistically significant(P<0.05).Comparison of the lowering rate of the odontoid process at 6-24 months after operation,and the comparison of ASIA neurological function scores at preoperation and postoperative 6-24 months showed statistically significant differences(P<0.05).According to the analysis of Pearson’s linear correlation method,the postoperative dentate movement was positively correlated with the ASIA nerve function score(P<0.05).Conclusion The lowering of the dentate after the skull base depression type refractory atlantoaxial dislocation has significant impact on the nerve function.Clinically,the lowering of the dentate can be promoted to improve the patients’ nerve function.