中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2014年
7期
658-662
,共5页
范涛%侯哲%赵新岗%赵思聪%邱军%梁聪
範濤%侯哲%趙新崗%趙思聰%邱軍%樑聰
범도%후철%조신강%조사총%구군%량총
颅底凹陷症%临床分型%显微外科手术%治疗效果
顱底凹陷癥%臨床分型%顯微外科手術%治療效果
로저요함증%림상분형%현미외과수술%치료효과
Basilar invagination%Clinical classification%Microsurgery%Treatment effect
目的 探讨先天性颅底凹陷症的临床分型、手术方法和疗效.方法 回顾性分析经手术治疗的103例颅底凹陷症.在Goel分类的基础上,将先天性颅底凹陷症进一步分为四型.根据不同类型颅底凹陷症的影像及临床特点,选择个体化的手术方法,并对其影像学及临床特点和手术方法的优劣进行综合评估.结果 103例患者中,101例术后疗效满意,JOA评分由术前(9.54±3.43)分提高至(12.76 ±2.53)分(t=4.732,P=0.036);54例合并寰齿间距增大的患者均获得部分或完全复位;71例合并脊髓空洞的患者中,49例明显缩小(>50%),21例缩小,1例无变化.随访到81例患者,随访时间12 ~ 72个月.JOA评分由术前的(9.20±2.47)分提高至(13.82±2.37)分(t=4.823,P=0.028).结论 根据寰枢脱位或脊髓空洞的有无,将先天性颅底凹陷症细分成四型,可准确反映复杂先天性颅底凹陷症的病理特征.通过临床表现结合影像学特征进行综合评估,选择个体化手术方案,可提高先天性颅底凹陷症的诊断和疗效.
目的 探討先天性顱底凹陷癥的臨床分型、手術方法和療效.方法 迴顧性分析經手術治療的103例顱底凹陷癥.在Goel分類的基礎上,將先天性顱底凹陷癥進一步分為四型.根據不同類型顱底凹陷癥的影像及臨床特點,選擇箇體化的手術方法,併對其影像學及臨床特點和手術方法的優劣進行綜閤評估.結果 103例患者中,101例術後療效滿意,JOA評分由術前(9.54±3.43)分提高至(12.76 ±2.53)分(t=4.732,P=0.036);54例閤併寰齒間距增大的患者均穫得部分或完全複位;71例閤併脊髓空洞的患者中,49例明顯縮小(>50%),21例縮小,1例無變化.隨訪到81例患者,隨訪時間12 ~ 72箇月.JOA評分由術前的(9.20±2.47)分提高至(13.82±2.37)分(t=4.823,P=0.028).結論 根據寰樞脫位或脊髓空洞的有無,將先天性顱底凹陷癥細分成四型,可準確反映複雜先天性顱底凹陷癥的病理特徵.通過臨床錶現結閤影像學特徵進行綜閤評估,選擇箇體化手術方案,可提高先天性顱底凹陷癥的診斷和療效.
목적 탐토선천성로저요함증적림상분형、수술방법화료효.방법 회고성분석경수술치료적103례로저요함증.재Goel분류적기출상,장선천성로저요함증진일보분위사형.근거불동류형로저요함증적영상급림상특점,선택개체화적수술방법,병대기영상학급림상특점화수술방법적우렬진행종합평고.결과 103례환자중,101례술후료효만의,JOA평분유술전(9.54±3.43)분제고지(12.76 ±2.53)분(t=4.732,P=0.036);54례합병환치간거증대적환자균획득부분혹완전복위;71례합병척수공동적환자중,49례명현축소(>50%),21례축소,1례무변화.수방도81례환자,수방시간12 ~ 72개월.JOA평분유술전적(9.20±2.47)분제고지(13.82±2.37)분(t=4.823,P=0.028).결론 근거환추탈위혹척수공동적유무,장선천성로저요함증세분성사형,가준학반영복잡선천성로저요함증적병리특정.통과림상표현결합영상학특정진행종합평고,선택개체화수술방안,가제고선천성로저요함증적진단화료효.
Objective To investigate the classification,personalized operative plan and therapeutic evaluation of basilar invagination.Methods The clinical data of 103 patients who accepted microsurgical treatment in our hospital were retrospectively analyzed.Based on Atul Goel classification,the basilar invagination were diagnosed and divided into four categories.The selected personalized operative plans,imaging features,clinical characteristics and surgical methods were evaluated.Results 101 of 103 cases achieved good outcomes.The main Japanese Orthopaedic Association (JOA)scale was increased from 9.54 ±3.43 to 12.76 ±2.53(t =4.732,P =0.036) after the procedures.A complete reduction or partial reduction was achieved in all patients who had increased atlantodental interval.In 71 patients with syringomyelia,the syringomyelia was obviously shrinked in 49 cases (> 50%),shrinked in 21,and unchanged in 1.81 cases were followed-up from 12 to 72 months.The JOA scale was improved from 9.20±2.47 to 13.82 ±2.37(t =4.823,P =0.028)after follow-up.Conclusions According to the existence of syringomyelia and(or) atlantoaxial dislocation,all the basilar invagination could be divided into four types,which chould accurately reflect the pathological features of complicated basilar invagination.Through the comprehensive assessment of clinical manifestation and imaging features,a personalized surgical procedure could be selected to improve the effects of treatment of congenital basilar invagination.