CAJ | 학술논문

目的探讨枕骨板障间螺钉固定枕颈融合术治疗颅颈部畸形的临床疗效.方法回顾性分析2010年1月-2013年1月南华大学附属第一医院收治的15例颅颈部畸形患者资料,其中男9例,女6例,年龄29 ～ 60岁(40.4±8.2)岁.Amold-Chiari畸形8例,寰枕融合并颅底扁平5例,颈椎分节不全(Klippel-Feil综合征)2例.术前CT和MRI检查均提示寰枢椎脱位合并脊髓不同程度受压.术前日本矫形外科协会(JOA)评分为6～10分,平均(8.1±1.7)分.所有患者入院后均行颅骨持续牵引,均采用枕骨板障间螺钉固定系统进行枕颈融合术.结果手术均顺利完成,手术时间100～220 min(140.2±30.5) min;出血量190 ～710 ml(272.2±73.4) ml.无脊髓血管损伤及其他严重并发症.术后第3天JOA评分9～ 14分,平均(11.0±2.1)分,较术前明显改善(t=0.003,P＜0.05).术后复查X线片、CT和MRI提示板障间螺钉位置均满意,没有螺钉穿透枕骨内板.除1例复位不良外,余14例均完全复位,脊髓受压完全解除.随访12～ 36个月,平均(22.0±6.3)个月,术后3～9个月(5.1±2.7)个月植骨均获得骨性融合,无断钉、断棒及内固定松动发生.末次随访时JOA评分为12～16分,平均(14.1±1.6)分.与术前比较明显改善,差异有统计学意义(t=0.002,P＜0.05).结论颅骨持续牵引结合枕骨板障间螺钉固定系统进行枕颈融合术具有固定牢靠、操作简单、方便植骨等优点,是治疗颅颈部畸形的有效方法.
목적 탐토침골판장간라정고정침경융합술치료로경부기형적림상료효.방법 회고성분석2010년1월-2013년1월남화대학부속제일의원수치적15례로경부기형환자자료,기중남9례,녀6례,년령29 ～ 60세(40.4±8.2)세.Amold-Chiari기형8례,환침융합병로저편평5례,경추분절불전(Klippel-Feil종합정)2례.술전CT화MRI검사균제시환추추탈위합병척수불동정도수압.술전일본교형외과협회(JOA)평분위6～10분,평균(8.1±1.7)분.소유환자입원후균행로골지속견인,균채용침골판장간라정고정계통진행침경융합술.결과 수술균순리완성,수술시간100～220 min(140.2±30.5) min;출혈량190 ～710 ml(272.2±73.4) ml.무척수혈관손상급기타엄중병발증.술후제3천JOA평분9～ 14분,평균(11.0±2.1)분,교술전명현개선(t=0.003,P＜0.05).술후복사X선편、CT화MRI제시판장간라정위치균만의,몰유라정천투침골내판.제1례복위불량외,여14례균완전복위,척수수압완전해제.수방12～ 36개월,평균(22.0±6.3)개월,술후3～9개월(5.1±2.7)개월식골균획득골성융합,무단정、단봉급내고정송동발생.말차수방시JOA평분위12～16분,평균(14.1±1.6)분.여술전비교명현개선,차이유통계학의의(t=0.002,P＜0.05).결론 로골지속견인결합침골판장간라정고정계통진행침경융합술구유고정뢰고、조작간단、방편식골등우점,시치료로경부기형적유효방법.
Objective To explore the clinical outcome of the treatment of craniovertebral anormalies through occipitocervical fusion by inter-diploe screw fixation.Methods From January 2010 to January 2013,15 patients (9 males,6 females) in the First Affiliated Hospital of University of South China were diagnosed with craniovertebral anormalies.The age ranged from 29 to 60 years (40.4 ± 8.2) years.Eight patients had Arnold-Chiari deformitory,5 patients had basilar invagination with os odontoidem,2 patients had Klippel-Feil deformitory.All the patients had symptoms of spinal medulla compression.The Japanese orthopaedic association(JOA) score of preoperation ranged from 6 to 10 (8.1 ± 1.7).All the patients received head-shoulders traction through modified Halo-vest for 1-2 weeks.All cases received occipitocervical fusion by inter-diploe screw-rod-pedicel screw system.Results All patients underwent this technique operation successfully.The mean operation time was 100-220 min (140.2 ± 30.5) min,and blood loose was 190-710 ml(272.2 ±73.4) ml.There was no neurological function worsen and severely complications.The JOA after operation 3 days was 9-14 (11.0 ± 2.1),there was statistical differences compared to preoperation (t =0.003,P ＜ 0.05).The postoperatively radological films indicated all the inter-diploe screw locations were satisfactory,there was no screw penetrating the medial occipital plate.All cases were followed up for 12-36 months(22.0 ± 6.3) months.Bone graft fusion was obtained in 3-9 months (5.1 ± 2.7) months.There was no internal fixation breakage and loosening.The JOA score of last follow-up was 12-16 (14.1 ± 1.6),there was statistical differences compared to preoperation(t =0.002,P ＜ 0.05).All patients with limb numbness,muscle weakness and other symptoms were obviously improved than preoperation.Conclusions Occipitocervical fusion using inter-diploe screw-rod-pedicel screw system,is an effective method for the treatment of craniovertebral anormalies with the advantage of rigid fixation,simple operation and convenient bone graft.