本文關(guān)鍵詞： 枕頸畸形 經(jīng)口咽入路 寰樞關(guān)節(jié)脫位 松解　出處：《中國矯形外科雜志》2017年15期 　論文類型：期刊論文

【摘要】：[目的]探討經(jīng)口咽寰樞椎松解復(fù)位后路枕骨大孔擴(kuò)大減壓枕頸固定融合術(shù)治療復(fù)雜枕頸畸形的臨床療效。[方法]回顧性分析2012年1月~2015年6月本科共收治并隨訪57例伴難復(fù)性寰樞關(guān)節(jié)脫位的復(fù)雜枕頸畸形患者的臨床資料。采用持續(xù)顱骨牽引下經(jīng)口咽寰樞椎松解復(fù)位+后路寰椎后弓切除枕骨大孔擴(kuò)大減壓枕頸固定植骨融合術(shù)治療此類畸形,術(shù)前、術(shù)后1、3、6及12個(gè)月隨訪時(shí)行JOA評(píng)分和頸椎X線片、CT、MR檢查,并測(cè)量齒狀突超過Chamberlain線距離、延髓脊髓角(CMA)、寰齒前間隙(ADI)、枕大孔正中有效矢狀徑,所有患者根據(jù)手術(shù)前后JOA、VAS、NDI評(píng)分和測(cè)量影像學(xué)相關(guān)徑線評(píng)價(jià)臨床療效。[結(jié)果]平均手術(shù)時(shí)間5.3 h,術(shù)中出血量62~220ml,術(shù)中置釘良好,未出現(xiàn)椎動(dòng)脈損傷和脊髓損傷加重,術(shù)后鼻飼3~7 d,2周出院。術(shù)后無口咽部感染病例,枕頸部感染2例,經(jīng)清創(chuàng)VSD負(fù)壓吸引后均治愈。術(shù)前JOA評(píng)分6~12分,VAS評(píng)分0~7分,NDI評(píng)分8~40分,術(shù)后12個(gè)月JOA評(píng)分10~17,VAS評(píng)分0~4分,NDI評(píng)分5~19分,與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義。術(shù)后復(fù)查影像學(xué)檢查示內(nèi)固定穩(wěn)定,植入骨塊達(dá)骨性融合,術(shù)后齒狀突超過腭枕線距離-10.00~6.90 mm;CMA 137.00°~159.50°,ADI值1.70~5.80 mm,枕大孔正中有效矢狀徑25.70~32.90 mm,分別與術(shù)前齒狀突超過腭枕線(Chamberlain線)距離5.30~16.70 mm;CMA 109.00°~129.80°,ADI值5.30~9.10 mm;枕大孔正中有效矢狀徑6.00~18.80 mm,比較差異均有統(tǒng)計(jì)學(xué)意義。[結(jié)論]枕頸畸形采用經(jīng)口咽寰樞椎松解復(fù)位后路枕骨大孔擴(kuò)大減壓枕頸固定融合術(shù)治療,可使齒狀突明顯下移,糾正寰樞脫位,解除脊髓壓迫,療效滿意。
[Abstract]:[objective] to investigate the clinical effect of the treatment of complex occipitocervical malformation by extended decompression and occipitocervical fusion through oropharynx atlantoaxial release and reduction. [methods] A retrospective analysis was made on the treatment of complex occipitocervical deformity from January 2012 to June 2015. The clinical data of 57 cases of complex occipitocervical malformation with irreducible atlantoaxial dislocation were investigated. Posterior pedicle resection of occipital foramen and extended occipitocervical fixation under continuous cranial traction through oropharyngeal atlantoaxial release and reduction. Fusion for the treatment of such deformities, Preoperative and 12 months follow-up were performed with JOA score and CT Mr of cervical vertebrae. The distance of odontoid process beyond Chamberlain line, medulla oblongata angle, anterior atlantoodontoid space, and the effective sagittal diameter of occipital foramen were measured. All the patients were evaluated according to the JOAA VASN NDI score before and after the operation and the radiography-related diameters. [results] the mean operative time was 5.3 h, the intraoperative blood loss was 62 ~ 220 ml, the nail placement was good, no vertebral artery injury and spinal cord injury were aggravated. Patients without oropharyngeal infection and 2 patients with occipitocervical infection were cured after debridement of VSD negative pressure. Preoperative JOA score ranged from 6 to 12 points and from 0 to 7 points. 12 months after operation, the JOA scores were 10 ~ 17, 0 ~ 4 and 5 ~ 19 respectively, which were significantly different from those before operation. The imaging examination showed that the internal fixation was stable, and the bone grafts were bony fused. After operation, the distance between the odontoid process and the occipital line was -10.00 鹵6.90 mm, CMA 137.00 擄and 159.50 擄ADI was 1.70 鹵5.80 mm, the median effective sagittal diameter of occipital foramen was 25.700.90 mm, which was 5.3016.70 mm longer than that before operation (CMA 109.00 擄129.80 擄ADI 5.309.10), and the median effective sagittal diameter of occipital foramen was 6.00 ~ 18.80 mm, respectively. [conclusion] the occipitocervical malformation was treated by transoropharyngeal atlantoaxial release reduction and extended occipital foramen decompression, occipitocervical fixation and fusion. The odontoid process can be obviously moved down, atlantoaxial dislocation can be corrected, spinal cord compression can be relieved, and the curative effect is satisfactory.
【作者單位】： 昆明醫(yī)科大學(xué)第一附屬醫(yī)院骨科;
【分類號(hào)】：R687.3

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