本文選題：頸枕融合術(shù) + C1-C2椎弓根螺釘技術(shù)��； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景寰樞椎位于顱頸交界區(qū)(craniovertebral junction)內(nèi),顱頸交界區(qū)為連接顱骨與頸椎的特殊結(jié)構(gòu),比鄰椎動脈、延髓及高位頸髓等結(jié)構(gòu)。對于寰樞椎脫位(Atlantoaxial dislocation)的瘤患者來說,致病的主要因素是由于寰樞椎穩(wěn)定性被破壞(Atlantoaxial instability)后所造成延髓及高位脊髓的壓迫。本病變致殘機(jī)率高、嚴(yán)重者可危及生命。隨著內(nèi)固定器械的發(fā)展和手術(shù)技術(shù)的進(jìn)步,針對寰樞椎脫位,目前治療方案多以后入路椎弓根釘-棒內(nèi)固定為主。由于顱頸交界區(qū)的結(jié)構(gòu)特殊造成此區(qū)域手術(shù)操作風(fēng)險(xiǎn)大,死亡率高,是目前研究的重點(diǎn)及難點(diǎn)。目的觀察C1-C2椎弓根螺釘-棒技術(shù)及頸枕融合術(shù)治療寰樞椎脫位的療效。方法回顧性分析2012年12月至2016年6月在鄭州大學(xué)第一附屬醫(yī)院神經(jīng)外科接受后入路椎弓根釘-棒內(nèi)固定技術(shù)治療的55例寰樞椎脫位患者,根據(jù)病情選擇并分別采用經(jīng)后入路C1-C2椎弓根螺釘-棒技術(shù)及頸枕融合術(shù)治療。術(shù)前使用JOA評分評估患者神經(jīng)功能情況,使用X線、CT、3T磁共振、CT三維重建進(jìn)行檢查,觀察患者寰樞椎前后根、椎弓根、寰樞關(guān)節(jié)、寰枕關(guān)節(jié)、椎動脈走形等情況并記錄ADI值、齒狀突與CL的距離值(記為CL)、CMA值。根據(jù)術(shù)前資料選擇C1-C2椎弓根螺釘-棒技術(shù)及頸枕融合術(shù)進(jìn)行治療。術(shù)中觀察并記錄出血量、手術(shù)時(shí)間、寰樞椎復(fù)位及置釘?shù)惹闆r。術(shù)后記錄患者一般情況及有無并發(fā)癥等情況。隨訪6~30個(gè)月,隨訪時(shí)記錄患者主訴、JOA評估、復(fù)查時(shí)CT和MRI所記錄的ADI值、CL值、CMA值及生活質(zhì)量評價(jià)表(SF-36生活質(zhì)量評估表)與術(shù)前資料進(jìn)行對比評估。根據(jù)術(shù)前、術(shù)后資料對比從而判定手術(shù)療效。結(jié)果入組的55例患者中,35例(63.6%)患者接受頸枕融合術(shù)治療,20例(36.6%)患者接受C1-C2寰樞椎椎弓根螺釘術(shù)治療,所有患者術(shù)中未發(fā)生椎動脈出血、神經(jīng)損傷等并發(fā)癥。術(shù)中X線及CT顯示置釘位置準(zhǔn)確。術(shù)后影像學(xué)示全部患者植骨及內(nèi)固定均良好。隨訪6~30個(gè)月,經(jīng)頸枕融合術(shù)治療組中32例(94%)患者癥狀較前緩解,2例(6%)癥狀無明顯緩解,33(94%)例植骨及內(nèi)固定均良好,1例(3%)因腦干大面積梗塞死亡,1例(3%)植骨融合失敗。術(shù)后7天JOA評分由術(shù)前(10.8±1.7)分提升到(11.6±1.6)分,ADI值由術(shù)前(8.17±2.862)mm下降到(2.79±0.55)mm,CL值(8.1±5.5)下降至(3.1±1.5)mm,CMA(130.1±10.3)提高至(152.7±6.2)°差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。末次隨訪JOA評分為13.2±1.7分,較術(shù)前及術(shù)后7天有明顯差異(P0.05)。經(jīng)C1-C2寰樞椎椎弓根螺釘術(shù)治療組,19例(95%)患者主訴癥狀較前緩解,1例(5%)癥狀無明顯緩解,全部20(100%)例植骨及內(nèi)固定均良好。術(shù)后7天JOA評分由術(shù)前(11.3±1.4)分提升到(12.1±1.5)分,ADI值由術(shù)前(7.13±2.762)mm下降到(2.69±0.45)mm,CL值(9.1±4.6)下降至(3.4±1.7)mm,CMA(128.1±11.3)提高至(156.7±7.2)°差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。末次隨訪JOA評分為13.9±1.4分,較術(shù)前及術(shù)后7天有明顯差異(P0.05)。通過SF-36生活質(zhì)量分別對兩組患者術(shù)前、術(shù)后的生理健康及心理健康進(jìn)行評估,結(jié)果有明顯差異(p0.05)結(jié)論1、C1-2椎弓根螺釘技術(shù)及頸枕融合術(shù)治療寰樞椎脫位安全有效。2、C1-2椎弓根螺釘技術(shù)及頸枕融合術(shù)治療寰樞椎脫位后,術(shù)后患者生活質(zhì)量明顯提高。
[Abstract]:Background the atlantoaxial junction is located in the craniofacial junction (craniovertebral junction). The craniofacial junction is a special structure connecting the skull and the cervical spine, compared with the adjacent vertebral arteries, the medulla oblongata and the high cervical pulp. For the patients with atlantoaxial dislocation (Atlantoaxial dislocation), the main cause of the disease is the stability of the atlantoaxial instability (Atlanto Axial instability causes the compression of the medulla and the high position of the spinal cord. This lesion has a high disability rate and a serious life. With the development of the internal fixation apparatus and the progress of the surgical technique, the main treatment scheme is mainly pedicle screw rod internal fixation for atlantoaxial dislocation. The regional operation is the key and difficult point of the present study. Objective To observe the effect of C1-C2 pedicle screw rod technique and cervical occipital fusion in the treatment of atlantoaxial dislocation. Methods a retrospective analysis was made on the pedicle screw fixation in the Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University from December 2012 to June 2016. 55 patients with atlantoaxial dislocation were selected and treated with C1-C2 Shiumi Ne screw rod technique and cervical occipital fusion respectively. Preoperative JOA score was used to evaluate the patient's nerve function. X-ray, CT, 3T magnetic resonance, and CT 3D reconstruction were used to observe the anterior and posterior atlantoaxial roots, Shiumi Ne, atlantoaxial clearance. Section, atlantooccipital joint, vertebral artery shape, ADI value, distance value of odontoid and CL (CL), CMA value. Select C1-C2 pedicle screw rod technique and cervical occipital fusion according to preoperative data. Intraoperative observation and recording of bleeding, operation time, atlantoaxial reduction and nailing were recorded. The patients were followed up for 6~30 months, followed up for 6~30, JOA assessment, ADI value, CL value, CL value, CMA value, and quality of life assessment table (SF-36 life quality assessment table) compared with the preoperative data at the time of review. The results were compared with the preoperative and postoperative data to determine the effect of the operation. Results the results were determined in 55 patients. 35 (63.6%) patients received cervical occipital fusion and 20 (36.6%) underwent C1-C2 atlantoaxial pedicle screw operation. All patients had no vertebral artery bleeding and nerve injury during the operation. The X-ray and CT showed the position of the nail in the operation. The symptoms of 32 (94%) patients in the occipital fusion group were relieved, 2 cases (6%) had no obvious relief, 33 (94%) had good bone graft and internal fixation, 1 cases (3%) died of large area infarction of the brain stem, 1 cases (3%) failed in bone graft fusion. The JOA score of 94% days after operation was raised to (10.8 + 1.7) points, and the value of ADI decreased to (mm). 2.79 + 0.55) mm, CL value (8.1 + 5.5) decreased to (3.1 + 1.5) mm, CMA (130.1 + 10.3) increased to (152.7 + 6.2) degree difference (P0.05). The last follow-up JOA score was 13.2 + 1.7, compared with preoperative and postoperative 7 days (P0.05). All 20 (100%) cases of bone graft and internal fixation were all good. The JOA score was raised to (12.1 + 1.5) points before operation (11.3 + 1.4), and the value of ADI decreased from (7.13 + 2.762) mm to (2.69 + 0.45) mm, and CL value (9.1 + 4.6) dropped to (P0.05) mm, and CMA (P0.05) was statistically significant (P0.05). The JOA score of the last follow-up was 13.9 + 1.4 points, compared with the preoperative and 7 days after the operation (P0.05). The physiological health and mental health of the two groups were evaluated before and after the SF-36 quality of life respectively. The results were significantly different (P0.05) 1. The C1-2 pedicle screw technique and the cervical occipital fusion were safe and effective in the treatment of atlantoaxial dislocation, C 1-2 after pedicle screw fixation and occipital fusion for atlantoaxial dislocation, the quality of life of the patients was significantly improved.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 潘冬生;宋振全;趙明光;張海松;陸宇;金振野;;術(shù)中CT輔助下椎弓根螺釘置入的精確性和安全性評估[J];中國臨床神經(jīng)外科雜志;2016年01期

2 楊利斌;;寰椎椎弓根螺釘進(jìn)釘通道的選擇[J];鄭州大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2014年02期

3 潘軍偉;黃大耿;郝定均;;寰樞椎失穩(wěn)癥的外科治療研究進(jìn)展[J];中國骨與關(guān)節(jié)損傷雜志;2014年03期

4 田紀(jì)偉;王雷;柳超;;齒狀突骨折的外科手術(shù)方式探討[J];中國矯形外科雜志;2013年23期

5 黃開;楊金華;王筱林;楊宗華;;后路寰樞椎椎弓根釘內(nèi)固定及融合術(shù)治療上頸椎不穩(wěn)11例[J];中國骨與關(guān)節(jié)損傷雜志;2013年05期

6 王建華;夏虹;尹慶水;吳增暉;艾福志;馬向陽;章凱;;基于椎動脈變異判別的Ⅲ代TARP鋼板治療寰樞椎脫位的個(gè)性化置釘[J];中國脊柱脊髓雜志;2013年05期

7 尹慶水;夏虹;馬向陽;劉景發(fā);王建華;白朝暉;麥小紅;;寰樞椎脫位規(guī)范化診治的臨床研究[J];中國骨科臨床與基礎(chǔ)研究雜志;2012年03期

8 邵將;賈連順;陳雄生;嚴(yán)望軍;張?jiān)?康輝;;難復(fù)性寰樞椎脫位的外科治療[J];中華骨科雜志;2010年02期

9 王建華;尹慶水;夏虹;吳增輝;;樞椎椎動脈孔分型對樞椎椎弓根置釘?shù)呐R床意義[J];中國脊柱脊髓雜志;2007年08期

10 譚明生;張光鉑;王文軍;譚遠(yuǎn)超;鄒海波;移平;蔣欣;韋z延，

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