本文選題：顱頸交界區(qū)畸形　切入點：脊髓空洞癥　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景顱頸交界區(qū)畸形的發(fā)生發(fā)展既有先天胚胎發(fā)育因素,又有后天病理生理學(xué)及生物力學(xué)改變的影響。表現(xiàn)形式多樣,很多情況下多種畸形并存,錯綜復(fù)雜。大多數(shù)伴有典型相關(guān)癥狀顱頸交界區(qū)畸形的首選治療仍然是外科手術(shù)治療,后路減壓與矯形復(fù)位內(nèi)固定術(shù)逐漸成為外科治療的主流術(shù)式。目的目前對于顱頸交界區(qū)畸形的分類和治療策略仍有爭論。本文通過回顧分析大宗臨床病例治療探討顱頸交界區(qū)畸形新的分類方法和個性化手術(shù)治療策略。方法收集2012年3月18日-2016年12月24日山東省立醫(yī)院神經(jīng)外科收治明確診斷的顱頸交界區(qū)畸形并行手術(shù)治療的患者110例,其中男38例,女72例,年齡12-67歲。試依據(jù)臨床表現(xiàn)和明確的相關(guān)影像學(xué)診斷,大體將其歸為三型,一型:Chiari畸形(Chiari malformation,CM);二型:寰樞椎脫位;三型:顱底凹陷。有時還可多種畸形并存且合并脊髓空洞癥(syringomyelia,SM)等。手術(shù)技術(shù)有減壓技術(shù)、矯形復(fù)位技術(shù)、內(nèi)固定技術(shù),可單獨行后顱窩減壓術(shù)或聯(lián)合矯形復(fù)位術(shù)和內(nèi)固定術(shù)。收集患者術(shù)前及術(shù)后臨床癥狀緩解情況、手術(shù)并發(fā)癥等情況;并隨訪3～48月,觀察癥狀緩解、并發(fā)癥等,并依據(jù)Lavender和Symon的臨床療效標(biāo)準(zhǔn)與頸椎 JO A(Japanese Orthopaedic Association Score for Cervical)評分系統(tǒng)對患者進行術(shù)前術(shù)后評估。利用統(tǒng)計學(xué)方法對結(jié)果進行分析,探討顯微外科治療治療顱頸交界區(qū)畸形的方法及療效。結(jié)果隨訪到顱頸交界畸形術(shù)后病人102例;單純后路減壓病人50例,其中硬膜外減壓的病人31例,硬膜下減壓的病人19例;后路減壓合并枕頸融合的病人44例;后路減壓合并枕頸融合的病人例的病人有8例。依據(jù)Lavender和Symon的臨床療效標(biāo)準(zhǔn);術(shù)后3個月內(nèi)的總有效率是86.27%,術(shù)后6個月以上的總有效率是92.16%;依據(jù)頸椎JOA評分系統(tǒng):術(shù)后3個月內(nèi)的治療改善率是83.17%,術(shù)后6個月以上的治療改善率是84.04%。手術(shù)前和手術(shù)后隨訪的臨床療效和頸椎JOA評分存在顯著改善,手術(shù)前和手術(shù)后隨訪的臨床療效和頸椎JOA評分存在顯著的相關(guān)關(guān)系,手術(shù)對于改善病人術(shù)后的臨床療效和頸椎JOA評分具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論根據(jù)不同臨床表現(xiàn)和影像學(xué)表現(xiàn)對顱頸交界區(qū)畸形復(fù)雜性作充分評估,制定個性化手術(shù)方案,可明顯改善病人預(yù)后,減少術(shù)后并發(fā)癥,提高病人日常生活質(zhì)量。頸后入路減壓手術(shù)是顱頸交界區(qū)畸形有效合理的治療方式,減壓的術(shù)式以及固定融合策略仍存在爭議,有待更多臨床數(shù)據(jù)的積累。頸后入路復(fù)位固定融合技術(shù)可以解決絕大多數(shù)的顱頸交界區(qū)畸形的矯形問題,安全有效,可以認為是首選手術(shù)方式。研究意義根據(jù)臨床癥狀和影像學(xué)檢查對先天性顱頸交界畸形采用臨床分類的方法,并選擇個體化的頸后入路手術(shù)方案對提高手術(shù)成功率和改善患者預(yù)后可能具有一定的意義。
[Abstract]:The development background of craniocervical junction malformation is the inherent factor of embryonic development, and the impact of acquired pathophysiology and biomechanics. Diverse forms, in many cases a variety of abnormalities coexist, perplexing. The most preferred treatment area malformation associated with typical symptoms of craniocervical junction is still the surgical treatment of posterior decompression and orthopedic fixation has gradually become the mainstream of surgical treatment for craniocervical junction. The purpose of the classification and treatment strategy of region malformation is controversial. This paper reviews the analysis of clinic treatment of craniocervical junction malformation new classification method and individualized surgical treatment. Methods from March 18, 2012 December 24th -2016 years in the Department of Neurosurgery of Shangdong Province-owned Hospital from the diagnosis of craniocervical junction malformation parallel operation treatment in 110 cases of patients, including 38 cases of male and female In 72 cases, age 12-67. Test based on the clinical manifestations and related image clear diagnosis, generally classified into three types, one type: Chiari malformation (Chiari malformation, CM); type two: atlantoaxial dislocation; type three: the sag. Sometimes also can coexist with various deformities with spinal cord syringomyelia (syringomyelia, SM). The surgical technique with decompression technique, orthopedic reduction, internal fixation, posterior fossa decompression can alone or combined with orthopedic reposition and internal fixation. The relief of clinical symptoms of patients were collected before and after surgery, surgical complications; and the follow-up of 3~48 months, to observe the symptoms and complications so, according to the clinical curative effect of standard Lavender and Symon and A (Japanese Orthopaedic Association cervical JO Score for Cervical) for patients with preoperative and postoperative assessment scoring system. Using statistical methods to analyze the results of microsurgical treatment. Treatment of craniocervical junction deformity and the curative effect. Results 102 patients were followed up with malformation of craniocervical junction; simple posterior decompression in 50 patients, including 31 cases of epidural decompression in patients with subdural decompression in 19 patients; 44 patients with posterior decompression and occipitocervical fusion of the patients after the road; decompression and occipitocervical fusion of the patients in the 8 cases. On the basis of clinical curative effect of standard Lavender and Symon; within 3 months after operation, the total efficiency is 86.27%, after more than 6 months the total efficiency is 92.16%; on the basis of cervical JOA scoring system: after 3 months of treatment in the improvement rate 83.17%, postoperative treatment for more than 6 months to improve the rate of 84.04%. before and after surgery and the clinical curative effect of cervical JOA score significantly improved follow-up, preoperative and postoperative clinical curative effect and follow-up of cervical JOA score are significantly related to the operation, to improve the postoperative patients The clinical curative effect and the cervical JOA score was statistically significant (P0.05). Conclusion according to different clinical manifestations and radiological manifestations of craniocervical junction malformation complex to evaluate, develop personalized operation scheme, can significantly improve the prognosis of patients, reduce the postoperative complications, improve the quality of daily life patients. Posterior approach decompression is cranial cervical junction malformation effective treatment, surgical decompression and fixation and fusion strategy is still controversial, needs more clinical data accumulation. Cervical posterior fixation and fusion technology can solve most of the craniocervical junction malformation correction problem, safe and effective, can be considered as the preferred surgical method. According to the research significance the clinical symptoms and imaging methods with the clinical classification of malformation of congenital craniovertebral junction, and the choice of individual cervical posterior surgery program on the master were successfully provided The rate and improvement of the patient's prognosis may be of certain significance.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.1

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