颅颈交界区畸形手术治疗临床疗效分析

Clinical efficacy analysis of surgical treatment for craniovertebral junction abnormalities

目的探讨颅颈交界区畸形行外科手术治疗的安全性和有效性。方法回顾性分析采用后路关节间撑开复位固定融合术或小骨窗寰枕减压术治疗的48例颅颈交界区畸形患者,其中,对寰枢椎脱位患者测量手术前后的寰齿前间隙ADI、齿状突顶点高出Chamberlain线的高度(O-CL)、斜坡-椎管角(CCA);对脊髓空洞患者比较手术前后脊髓空洞大小,使用mJOA评分评价神经功能恢复情况。结果寰枢椎脱位患者的ADI由术前(9.67±1.82)mm减小至(3.53±1.61)mm,O-CL由术前的(9.40±3.77)mm减小至(1.97±2.12)mm,CCA由术前的(140.85±8.34)°增大至(147.63±9.43)°;32例脊髓空洞患者中,空洞较前缩小21例,空洞无变化11例,未出现空洞较前增大患者。术后mJOA评分由术前的13.9分增加至15.4分。上述数据在手术前后的差异均有统计学意义(P<0.01)。结论后路关节间撑开复位固定融合术或小骨窗寰枕减压术治疗颅颈交界区畸形安全、有效,值得临床推广应用。

Objective To investigate the efficacy and safety of surgical treatment for craniovertebral junction abnormalities.Methods A retrospective analysis was performed on 48 craniovertebral junction abnormalities patients who underwent posterior joint bracing reduced fixation and fusion or alto-occipital decompression approach.The atlantodental interval(ADI),the height of the odontoid process above the Chamberlain line(O-CL),and the clivus-canal angle(CCA)were measured before and after operation in atlantoaxial dislocation patients.The size of spinal cavity was compared in syringomyelia patients before and after operations.The effect of nerve function recovery was evaluated by modified Japanese Orthopaedic Association score(mJOA).Results ADI decreased from preoperative(9.67±1.82)mm to postoperative(3.53±1.61)mm,O-CL decreased from preoperative(9.40±3.77)mm to postoperative(1.97±2.12)mm,CAA increased from(140.85±8.34)°to(147.63±9.43)°.Of 32 patients with syringomyelia,the size of the spinal cavity got smaller in 21 patients,11 cases were unchanged,and no patient got an enlarged spinal cavity compared with thosepreoperatively.The mJOA score was followed up and increased from 13.9 to 15.4.There were statistically significant differences in the above databefore and after surgery(P<0.01).Conclusion Posterior joint bracing reduced fixation and fusion or alto-occipital decompression approach for the treatment of craniovertebral junction abnormalities is safe and effective,and is worthy of clinical recommendation.