CAJ | 학술논문

目的探讨枕颈内固定并植骨融合治疗先天性复杂寰枕畸形的疗效.方法回顾性分析21例复杂寰枕畸形患者,其中17例行后颅窝减压+枕颈植骨固定融合术,4例行经口咽寰枢椎间软组织及骨性组织切除减压,齿状突复位减压+后路后颅窝枕骨大孔减压术+枕颈植骨固定融合术；术后随访3个月至3年.结果寰枢脱位并存在延颈髓腹、背侧受压者,选择经口咽寰枢椎间软组织及骨性组织切除减压齿状突复位减压+后路后颅窝枕骨大孔减压术+枕颈植骨固定融合术,疗效满意.硬脑膜扩大修补与否及小脑扁桃体切除术与否与最终远期疗效无关；伴有多节段脊髓空洞症者行脊髓空洞“T”管蛛网膜下腔引流.本组治愈14例,有效7例.结论针对Chiari畸形解剖变异大的特点以及合并症形成的机制,选择不同的手术方案,提高手术治疗的远期疗效.
목적 탐토침경내고정병식골융합치료선천성복잡환침기형적료효.방법 회고성분석21례복잡환침기형환자,기중17례행후로와감압+침경식골고정융합술,4례행경구인환추추간연조직급골성조직절제감압,치상돌복위감압+후로후로와침골대공감압술+침경식골고정융합술；술후수방3개월지3년.결과 환추탈위병존재연경수복、배측수압자,선택경구인환추추간연조직급골성조직절제감압치상돌복위감압+후로후로와침골대공감압술+침경식골고정융합술,료효만의.경뇌막확대수보여부급소뇌편도체절제술여부여최종원기료효무관；반유다절단척수공동증자행척수공동“T”관주망막하강인류.본조치유14례,유효7례.결론 침대Chiari기형해부변이대적특점이급합병증형성적궤제,선택불동적수술방안,제고수술치료적원기료효.
Objective To investigate the effects of occipitocervical fixation and bone grafting fusion for the treatment of complicated congenital occipitocervical malformations.Methods A retrospective analysis of 21 cases of complicated occipitocervical malformation patients was performed.Seventeen cases underwent posterior cranial decompression bone grafting and fixation of occipital cervical fusion.Four cases underwent soft tissue and bony tissue resection,decompression of odontoid process reset decompression,posterior foramen magnum decompression,bone grafting and fixation of occipital cervical fusion.All patients were followed up by 3 months to 3 years.Results For the patient with atlantoaxial dislocation and the presence of intra-axial ventral,dorsal compression,good effects could be achieved through soft tissue and bony tissue resection,posterior foramen magnum decompression,bone grafting and fixation of occipital cervical fusion.There was no relationship between dural matter repair,cerebellum tonsil resection and final effects.For the patient with segmental syringomyelia,spinal cord subarachnoid drainage should be done.Conclusions Different operation scheme should be considered according to the anatomic variation and formation mechanism of complicated occipitocervical malformations to improve the long-term surgical effects.