角度量化复位方法在颅底凹陷合并寰枢椎脱位治疗中的临床应用

Clinical application of a quantitative method of atlantoaxial reduction angle in basilar invagination

目的探讨角度量化复位方法在颅底凹陷合并寰枢椎脱位治疗中的临床效果。方法回顾性分析2020年5月至2022年5月重庆医科大学附属第一医院神经外科收治的38例颅底凹陷合并寰枢椎脱位患者的临床和影像学资料。男性5例,女性33例,年龄(53.5±9.9)岁(范围:38~80岁)。患者均行后路C1~2小关节间融合器置入+枕颈间悬臂压棒复位术治疗,术前利用前期研究建立的寰枢椎复位几何模型测算复位角度,根据测算结果制备成品预弯钛棒,术中进行角度量化复位。采用配对样本t检验比较理论复位角度和实际复位角度的差异。结果所有患者顺利完成手术,斜坡枢椎角的术前理论复位角度为(10.62±1.78)°(范围:6.40°~13.20°),实际复位角度为(10.53±1.63)°(范围:6.70°~13.30°),差异无统计学意义(t=1.688,P=0.100);术前测算的理论术后后枕颈角为(117.37±5.88)°(范围:107.00°~133.00°),术后实际测量为(118.25±6.77)°(范围:105.40°~135.80°),差异亦无统计学意义(t=-0.737,P=0.466)。患者术后随访均>6个月,症状均明显改善,小关节间融合满意,未出现切口感染、内固定断裂、移位,无寰枢椎再失位等远期并发症。结论在颅底凹陷合并寰枢椎脱位的治疗中,角度量化复位方法可术前测算斜坡枢椎角的理论复位角度,指导术前制备相应角度的预弯钛棒,实现寰枢椎复位的角度量化。

Objectives To investigate the clinical application effect of a quantitative method of atlantoaxial reduction angle in basilar invagination.Methods A retrospective analysis of clinical and radiographic data was conducted of 38 patients with complicated atlantoaxial dislocation and basilar invagination admitted to the Department of Neurosurgery,First Affiliated Hospital of Chongqing Medical University from May 2020 to May 2022.There were 5 males and 33 females,aged(53.5±9.9)years(range:38 to 80 years).All patients underwent C1-2 interarticular fusion cage implantation+occipital-cervical fixation by pressing rob with the cantilever technique.The atlantoaxial reduction model of previous studies by our team was used to calculate the reduction angles before surgery.Then titanium rods of prebending angle were prepared according to the calculation before the operation.After that quantitative reduction of angle was performed during the operation.The paired t-test was used to compare the difference between the theoretical and actual reset value.Results The theoretical reduction angle of all patients was(10.62±1.78)°(range:6.40°to 13.20°),the actual reduction angle was(10.53±1.63)°(range:6.70°to 13.30°)and there was no statistical difference between them(t=1.688,P=0.100).The theoretical posterior occipitocervical angle after the operation of all patients was(117.37±5.88)°(range:107.00°to 133.00°),the actual posterior occipitocervical angle after the operation was(118.25±6.77)°(range:105.40°to 135.80°)and there was no statistical difference between them(t=-0.737,P=0.466).The postoperative follow-up time of the patients was more than 6 months and the symptoms of all patients were relieved.All patients had satisfactory fusion between small joints without incision infection,internal fixation fracture,displacement,atlantoaxial redislocation,and other long-term complications.Conclusion The quantitative method of atlantoaxial reduction angle in basilar invagination can calculate the theoretical reduction angle of the clivus axis angle and guide the preparation of the pre-bending titanium rod before surgery,so as to realize the quantification of the atlantoaxial reduction angle.