【作者】 胡希恒；

【导师】 张宏其；

【作者基本信息】 中南大学 ， 外科学， 2012， 博士

【摘要】 目的：探讨颅骨牵引结合后路枕颈融合术治疗部分枕颈部畸形所致寰枢椎脱位中的临床疗效。方法：回顾性研究2004年1月～2011年6月收治的28例枕颈部畸形所致寰枢椎脱位的病例,男18例,女10例；年龄为13～56岁,平均31.1±14.2岁。其中颅底凹陷(扁平)畸形16例(伴有寰椎枕骨化畸形8例,伴有寰枢椎椎弓根发育畸形6例,上述两种畸形皆有者2例),单纯寰椎枕骨化畸形6例,齿状突发育不良4例,单纯寰枢椎椎弓发育畸形2例。MRI示所有病例脊髓均不同程度受压,术前JOA评分平均7.2±1.4分。所有患者术前均行颅骨牵引术,牵引重量平均5.2±0.7Kg；牵引时间平均10.1±2.1天；然后复查X线片,22例患者脱位未能完全复位,6例患者脱位完全复位。术中枢椎尽量置椎弓根钉,根据枢椎的畸形程度,术中有20例患者置双侧椎弓根钉,6例患者置单侧椎弓根钉,2例患者未能置钉,余固定节段置侧块钉(一般固定在畸形椎体下2-3节段)。结果：全部病例手术均安全完成,手术平均用时3.5小时(3-5小时),术中平均出血约250m1(180-400m1)；无脊髓及血管损伤及其他严重并发症。术后第一天JOA评分平均为10.6±1.5分,较术前明显改善(p<0.05)。术后复查X线、MRI提示：21例患者脱位基本复位,7例患者脱位较术前明显改善,神经压迫完全解除。全部患者随访6-48个月,术后平均随访20.3±9.7个月,所有病例平均4.3±0.9个月均获得骨性融合。末次随访时,临床症状消失者20例,较前明显缓解者8例,JOA评分平均为14.6±1.7分,较术前及术后第一天均有改善(p<0.05)。随访期间内固定未见松动断裂发生。结论：颅骨牵引结合后路枕颈融合术治疗部分枕颈部畸形所致的寰枢椎脱位疗效确切,安全可靠,是部分寰枕畸形所致的寰枢椎脱位的最佳治疗选择。更多还原

【Abstract】 Objective:To investigate clinical effects of skull traction and posterior occipital-cervical fusion in treating part of atlantoaxial dislocation caused by craniovertebral anomalies.Methods:From January2004to June2011,28patients,which as18males and10females aged from13to56years old with a mean of31.1±14.2years old, were diagnosed with atlantoaxial dislocation caused by craniovertebral anomalies, including16basilar impression patients (8with occipitallization of the atlas,6with hypoplasia of atlantoaxial’s vertebral arch,2with the both deformity),6only occipitallization of the atlas,4odontoid hypoplasia,2only hypoplasia of atlantoaxial’s vertebral arch. MRI showsed all patients’spinal cords were compressed with a mean of7.2±1.4according to JOA scoring system. All the patients underwent skull traction, with a mean of traction weight5.2±0.7Kg and traction time10.1±2.1days, and then X-ray showed that:22patients’ dislocation had not total reduction, and6total reduction. Osterior occipital-cervical fusion surgery was taken, and during the operation, pedicle screws in axis should be implanted as far as possible, according to the deformity of axis,20patients had been implanted bilateral pedicle screws,6patients unilateral pedicle screws and2patients no pedicle screws, other fixed segments implanted lateral mass screws(usually2-3segments below the lowest deformity vertebral body). Results:All the patients underwent the skull traction and occipitocervical fusion surgery successfully without any neurological deficit or vascular injury. The average operation time was3.5hours and blood loss was250ml. No severe complications were noticed. JOA score of the first day after operation was10.6±1.5, much better than preoperation (p<0.05). X-ray and MRI after operation showed that21patients’dislocation had been total reduction and7much better than preoperation, and compression ofspinal cords were total relief of all patients. The follow-up was6-48months, and the average follow-up was20.3±9.7months, and all cases had solid bony fusion at an average4.3±0.9months. At the last follow-up,20patients were recovery well and8patients were much better with a mean of14.6±1.7according to JOA scoring system,much better than preoperation and the first day after operation (p<0.05) During the follow-up, the internal fixations had no loosened or broken.Conclusion:The skull traction and posterior occipital-cervical fusion surgery is effective and feasible in treating part of atlantoaxial dislocation caused by craniovertebral anomalies, and is the optimum therapeutic schedule for part of atlantoaxial dislocation caused by craniovertebral anomalies更多还原