| 王达义,常巍,尚晖,等.经口咽前路控制性松解复位+后路枕颈融合内固定术治疗颅底凹陷症.骨科,2015,6(4): 177-182. |
| 经口咽前路控制性松解复位+后路枕颈融合内固定术治疗颅底凹陷症 |
| Transoralpharyngeal atlantoaxial release and reduction controllably and posterior occipitocervical fusion in the treatment of basilar invagination |
| 投稿时间：2015-03-03 |
| DOI：10.3969/j.issn.1674-8573.2015.04.003 |
| 中文关键词: 颅底凹陷症 控制性复位 后路枕颈融合 |
| 英文关键词: Basilar invagination Reduction controllably Posterior occipitocervical fusion |
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| 中文摘要: |
| 目的 探讨经口咽寰枢关节控制性松解并短节段撑开复位+后路枕颈融合内固定术治疗颅底凹陷症的临床疗效。方法 2011年3月至2014年4月我科共收治5例颅底凹陷症合并严重寰枢椎畸形女性患者，采取前路经口咽控制性松解短节段撑开复位齿状突＋后路融合固定手术，年龄8.0～45.0岁，平均30.6岁。术前、术后测量齿状突顶点至Chamberlain线的垂直距离、寰齿间距（atlantodental interval，ADI）及延髓颈髓角（cervicomedullary angle，CMA）和/或斜坡枢椎角评估复位效果；应用日本骨科学会（Japanese Orthopaedic Association，JOA）神经评分标准评价临床症状改善情况。结果 术后测量齿状突顶点至Chamberlain线的垂直距离值、ADI和斜坡枢椎角均恢复正常。平均随访18.3个月，JOA 评分由术前平均8.8分提高到术后平均13.0分，所有病例均无并发症发生。结论 采用前路经口咽松解通过控制齿突复位程度（一般不超过10 mm），结合后路固定融合术治疗颅底凹陷症具有复位效果好、能控制手术风险、并发症少的优点。 |
| 英文摘要: |
| Objective To evaluate the clinical results of transoralpharyngeal atlantoaxial release and reduction controllably with posterior occipitocervical fusion in the treatment of basilar invagination. Methods From Mar. 2011 to Apr. 2014, 5 female patients with basilar invagination underwent surgically treatment. The mean age is 30.6 years (range 8.0-45.0 years). The atlantoaxial deformity was released and reduced controllably and posterior occipitocervical fusion was performed, the vertical dimension between odontoid process peak with Chamberlain line, atlanto-odontoid space and cervico-medullary angle of per-operation and post-operation were measured. Assess the clinical results with Japanese Orthopaedic Association (JOA) scores. Results The mean follow-up period was 18.3 months, all patients' the vertical dimension between odontoid process peak with Chamberlain line, atlanto-odontoid space and cervicomedullary angle were returned to normal almost. All patients achieved neurological function improvement, JOA scores from 8.8 returned to 13.0. No severe complications were found in this group. Conclusion Anterior atlantoaxial release and reduction controllably by trans-oralpharyngeal approach with posterior occipitocervical fusion are a safe and valid technique in the treatment of basilar invagination with serious atlantoaxial deformity. |
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