先天性顱底凹陷癥的細化分型及臨床分析
發(fā)布時間：2018-11-18 19:12
【摘要】：目的探討先天性顱底凹陷癥的細化分型及臨床特征。方法回顧性分析2005年6月至2013年12月在我院收治的139例顱底凹陷癥患者的完整資料,在Goel分型基礎(chǔ)之上根據(jù)其是否合并脊髓空洞將先天性顱底凹陷癥進一步分為四型:1 BIa+0型:顱底凹陷,寰齒間距增大,不合并脊髓空洞;2 BIa+S型:顱底凹陷,寰齒間距增大,合并脊髓空洞;3 BIb+0型:顱底凹陷,寰齒間距無增大,不合并脊髓空洞;4 BIb+S型:顱底凹陷,寰齒間距無增大,合并脊髓空洞。均從患者年齡、性別、體重、臨床表現(xiàn)、頸椎MRI、MRI-Cine、顱頸交界區(qū)三維CT重建、手術(shù)前后JOA評分及相關(guān)神經(jīng)功能等方面進行分析。結(jié)果139例患者中,BIa+0型31例(22.3%),BIa+S型45例(32.4%),BIb+0型21例(15.1%),BIb+S型42例(30.2%),其中BIa+0型和BIb+0型以腦干受壓引起的四肢無力、錐體束征及小腦損害引起的平衡及共濟失調(diào)為主,BIa+S型和BIb+S型既含有腦干受壓癥狀,同時還含有以脊髓中央管周圍受損引起的節(jié)段性分離性感覺障礙及肌肉萎縮等脊髓空洞癥狀。四種分型在年齡、性別及體重因素上不存在統(tǒng)計意義上的差異性(p0.05)。分別在手術(shù)前后,對患者進行了JOA評分及對可出現(xiàn)潛在神經(jīng)損傷的相關(guān)功能進行評測,并對結(jié)果進行統(tǒng)計分析。結(jié)果表明,經(jīng)分型診斷治療后,患者的病情普遍能得到改善。JOA評分中:BIa+0型病人分值可由術(shù)前的10.97上升至術(shù)后的12.45,術(shù)后JOA評分平均提高30.78%;BIa+S型病人分值可由術(shù)前的10.78上升至術(shù)后的12.76,術(shù)后JOA評分平均提高35.09%;BIb+0型病人分值可由術(shù)前的11.71上升至術(shù)后的13.57,術(shù)后JOA評分平均提高36.57%;BIb+S型病人分值可由術(shù)前的10.95上升至術(shù)后的12.71,術(shù)后JOA評分平均提高31.92%。潛在神經(jīng)損傷的相關(guān)功能評測中,經(jīng)分型診斷治療后,其中各組的術(shù)后改善率分別為:BIa+0,86.5%;BIa+S,88.4%;BIb+0,83.7%;BIb+S,79.1%。結(jié)論對于先天性顱底凹陷癥實施有效的臨床治療,需要我們對顱頸交界區(qū)部位的神經(jīng)生理及骨性解剖結(jié)構(gòu)取得深入的研究了解。本課題中依托頸椎MRI、MRICine及顱頸交界區(qū)三維CT重建檢查,可清晰顯示顱頸交界區(qū)病變及解剖結(jié)構(gòu),根據(jù)寰樞椎脫位及脊髓空洞的有無,將先天性顱底凹陷癥細分為四型,可準確反映復雜先天性顱底凹陷癥復雜的臨床病理特征,促進病人的臨床康復,降低臨床手術(shù)風險,并為手術(shù)方案的制訂提供可靠依據(jù)。
[Abstract]:Objective to study the classification and clinical features of congenital skull base depression. Methods the complete data of 139 patients with skull base depression admitted in our hospital from June 2005 to December 2013 were retrospectively analyzed. On the basis of Goel classification, congenital skull base depression was further divided into four types according to whether it was combined with syringomyelia: (1) BIa 0 type: skull base depression, atlantodentate space increased, and syringomyelia was not associated with syringomyelia; (2) BIa S type: cranial base depression, atlantodentate space increased, accompanied with syringomyelia; 3 BIb 0 type: skull base depression, atlantodentate space was not increased, without syringomyelia; 4 BIb S type: skull base depression, atlantodentate space was not increased, and syringomyelia was associated with syringomyelia. All patients were analyzed from age, sex, body weight, clinical manifestation, three-dimensional CT reconstruction of craniocervical junction of cervical MRI,MRI-Cine, JOA score and related nerve function before and after operation. Results among the 139 patients, 31 cases (22.3%) were BIa 0 type), BIa S (32.4%), BIb 0 type (42 cases) (15.1%), BIb S type 42 cases), and (32.4%), BIb 0 type (42 cases (30.2%). Among them, BIa 0 and BIb 0 were characterized by limb weakness caused by brainstem compression, pyramidal beam sign and balance and ataxia caused by cerebellar damage., BIa S and BIb S type had both brainstem compression symptoms. At the same time, there are some syringomyelia symptoms such as segmental dissociative sensory disorder and muscular atrophy caused by injury around the central canal of spinal cord. There was no statistical difference in age, sex and body weight among the four types (p0.05). Before and after operation, the patients were evaluated with JOA score and related functions of potential nerve injury, and the results were statistically analyzed. The results showed that after the diagnosis and treatment, the patients' condition could be improved generally. Among the JOA scores, the scores of BIa 0 patients increased from 10.97 before operation to 12.45 after operation, and the average JOA score increased 30.78% after operation. The score of BIa S patients increased from 10.78 before operation to 12.76 after operation, and the JOA score increased 35.09 on average after operation. The score of BIb 0 patients increased from 11.71 before operation to 13.57 after operation, and the JOA score increased 36.57 on average after operation. The score of BIb S patients increased from 10.95 before operation to 12.71 after operation, and the average JOA score increased 31.922 after operation. In the functional evaluation of the potential nerve injury, the improvement rate of each group after the diagnosis and treatment of the potential nerve injury was as follows: BIa 0 / 86.5 / BIa / S88.4 / BIb / 83.7B / S 79.1 / B respectively. Conclusion the effective clinical treatment of congenital skull base depression requires us to study the neurophysiology and bone anatomy of craniocervical junction. Based on MRI,MRICine of cervical vertebra and 3D CT reconstruction of craniocervical junction, the lesion and anatomical structure of craniocervical junction can be clearly displayed. According to the presence or absence of atlantoaxial dislocation and syringomyelia, congenital skull base depression can be subdivided into four types. It can accurately reflect the complex clinicopathological characteristics of complex congenital skull base depression, promote the clinical rehabilitation of patients, reduce the clinical operation risk, and provide reliable basis for the formulation of surgical plan.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.1
本文編號：2340926
[Abstract]:Objective to study the classification and clinical features of congenital skull base depression. Methods the complete data of 139 patients with skull base depression admitted in our hospital from June 2005 to December 2013 were retrospectively analyzed. On the basis of Goel classification, congenital skull base depression was further divided into four types according to whether it was combined with syringomyelia: (1) BIa 0 type: skull base depression, atlantodentate space increased, and syringomyelia was not associated with syringomyelia; (2) BIa S type: cranial base depression, atlantodentate space increased, accompanied with syringomyelia; 3 BIb 0 type: skull base depression, atlantodentate space was not increased, without syringomyelia; 4 BIb S type: skull base depression, atlantodentate space was not increased, and syringomyelia was associated with syringomyelia. All patients were analyzed from age, sex, body weight, clinical manifestation, three-dimensional CT reconstruction of craniocervical junction of cervical MRI,MRI-Cine, JOA score and related nerve function before and after operation. Results among the 139 patients, 31 cases (22.3%) were BIa 0 type), BIa S (32.4%), BIb 0 type (42 cases) (15.1%), BIb S type 42 cases), and (32.4%), BIb 0 type (42 cases (30.2%). Among them, BIa 0 and BIb 0 were characterized by limb weakness caused by brainstem compression, pyramidal beam sign and balance and ataxia caused by cerebellar damage., BIa S and BIb S type had both brainstem compression symptoms. At the same time, there are some syringomyelia symptoms such as segmental dissociative sensory disorder and muscular atrophy caused by injury around the central canal of spinal cord. There was no statistical difference in age, sex and body weight among the four types (p0.05). Before and after operation, the patients were evaluated with JOA score and related functions of potential nerve injury, and the results were statistically analyzed. The results showed that after the diagnosis and treatment, the patients' condition could be improved generally. Among the JOA scores, the scores of BIa 0 patients increased from 10.97 before operation to 12.45 after operation, and the average JOA score increased 30.78% after operation. The score of BIa S patients increased from 10.78 before operation to 12.76 after operation, and the JOA score increased 35.09 on average after operation. The score of BIb 0 patients increased from 11.71 before operation to 13.57 after operation, and the JOA score increased 36.57 on average after operation. The score of BIb S patients increased from 10.95 before operation to 12.71 after operation, and the average JOA score increased 31.922 after operation. In the functional evaluation of the potential nerve injury, the improvement rate of each group after the diagnosis and treatment of the potential nerve injury was as follows: BIa 0 / 86.5 / BIa / S88.4 / BIb / 83.7B / S 79.1 / B respectively. Conclusion the effective clinical treatment of congenital skull base depression requires us to study the neurophysiology and bone anatomy of craniocervical junction. Based on MRI,MRICine of cervical vertebra and 3D CT reconstruction of craniocervical junction, the lesion and anatomical structure of craniocervical junction can be clearly displayed. According to the presence or absence of atlantoaxial dislocation and syringomyelia, congenital skull base depression can be subdivided into four types. It can accurately reflect the complex clinicopathological characteristics of complex congenital skull base depression, promote the clinical rehabilitation of patients, reduce the clinical operation risk, and provide reliable basis for the formulation of surgical plan.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.1
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