寰枢椎侧块融合器用于治疗颅底凹陷伴寰枢椎脱位的临床疗效

Therapeutic effect of atlantoaxial lateral mass fusion cage for the treatment of basilar invagination with atlantoaxial dislocation

目的探讨寰枢椎侧块融合器用于治疗颅底凹陷(BI)伴寰枢椎脱位(AAD)的临床疗效。方法分析2018年3月至2022年3月在郑州大学第一附属医院接受后路植入寰枢椎侧块融合器联合枕颈融合内固定术的患者共22例,其中男4例,女18例。术前及术后测量寰齿间距(ADI)和延髓颈髓角(CMA),采用日本骨科协会(JOA)评分进行术前术后神经功能评价。术后定期随访X线、CT及MRI,评价复位、内固定及植骨融合情况。手术前后指标比较采用t检验。结果22例患者均成功完成手术并获得有效复位。手术时间(167.72±34.51)min;出血量(180.45±78.65)ml。术后ADI为(2.02±0.42)mm,较术前明显缩小(7.62±1.96)mm;CMA由术前(129.00±6.39)°恢复至术后(151.00±4.73)°;JOA评分从术前(11.14±2.27)分上升至术后(15.27±1.64)分,差异均有统计学意义(t=12.961、19.402、11.615,P<0.05)。所有患者神经压迫症状均予以解除,临床症状有不同程度改善。术后随访3~18个月,随访(8.62±3.85)个月。所有患者内固定良好,融合器位置满意,临床疗效满意。结论经后路置入寰枢椎侧块融合器是一种有效的治疗方法,远期并发症风险小,寰枢融合率良好,安全性和远期疗效良好。

Objective To explore the clinical efficacy of the atlantoaxial lateral mass fusion cage in the treatment of basilar invagination with atlantoaxial dislocation.Methods The analysis was conducted on a total of 22 patients who underwent posterior placement of atlantoaxial lateral mass fusion cage combined with occipital cervical fusion internal fixation surgery at the First Affiliated Hospital of Zhengzhou University from March 2018 to March 2022,including 4 males and 18 females.Before and after surgery,the atlantodental interval(ADI)and cervicomedullary angle(CMA)were measured,and the Japanese Orthopaedic Association(JOA)score was used for preoperative and postoperative neurological function evaluation.Regular examinations of X-ray,CT,and MRI were carried out after surgery to evaluate reduction,internal fixation,and bone graft fusion.Results Totally,22 patients successfully completed the surgery and achieved effective reduction.The surgical time was(167.72±34.51)min.The bleeding volume was(180.45±78.65)ml.The postoperative ADI was(2.02±0.42)mm,which was significantly reduced compared to the preoperative(7.62±1.96)mm.The CMA recovered from preoperative(129.00±6.39)°to postoperative(151.00±4.73)°.The JOA score increased from preoperative(11.14±2.27)to postoperative(15.27±1.64),with statistically significant differences(t=12.961,19.402,11.615,P<0.05).All patients with nerve compression symptoms were relieved,and clinical symptoms were improved to varying degrees.Postoperative follow-up was 3-18 months,with an average of(8.62±3.85)months.All patients had good internal fixation,satisfactory position of the atlantoaxial lateral mass fusion cage,and satisfactory clinical results.Conclusion Posterior placement of the atlantoaxial lateral mass fusion cage combined with occipitocervical fusion internal fixation is an effective treatment method,with low risk of long-term complications,good atlantoaxial fusion rate,good safety and long-term efficacy.