颅底凹陷合并难复性寰枢椎脱位术后齿状突下移程度对神经功能影响的临床研究

目的分析颅底凹陷合并难复性寰枢椎脱位术后齿状突下移程度与术后神经功能恢复的关系。方法回顾性分析2010—2018年在我院诊断为颅底凹陷合并难复性寰枢椎脱位并行后路减压治疗的患者19例,其中男10例,女9例;平均(41.89±14.27)岁;病程持续(42.61±70.71)个月。10例合并寰枕融合,7例合并Klippel-Feil综合征,4例合并椎动脉发育畸形,无病例合并小脑扁桃体疝及脊髓空洞等。测量术前及末次随访寰齿前间隙(anterior atlantodental interval,AADI)、斜坡齿突角(clivo-axial angle,CXA)及齿状突上移程度(the distance of the tip of odontoid to the McRae line,McRL),采用日本骨科协会评分(Japanese orthopaedic association scores,JOA)评估神经功能。对JOA评分改善率与齿状突下移率(odontoid descent rate,ODR)、寰齿前间隙变化(△AADI)和斜坡齿突角变化(△CXA)进行相关性分析。结果本组患者获得随访时间10~79个月,平均随访时间(20.42±8.24)个月。术前JOA为(11.21±2.62)分,末次随访JOA为(14.53±2.19)分,平均JOA改善率为(58.75±24.43)%。JOA评分改善率与ODR存在相关关系(R=0.88,P<0.05),与△AADI(R=0.07,P=0.77)及△CXA(R=-0.04,P=0.98)无明显相关性。结论难复性寰枢椎脱位合并颅底凹陷的手术疗效与齿状突复位率相关。

Influence of Odontoid Descent on Postoperative Neurological Function in Basilar Invagination with Irreducible Atlantoaxial Dislocation

Objective To evaluate the relationship between odontoid descent and postoperative neurological function.Methods 19 patients who underwent foramen magnum decompression for basilar invagination with irreducible atlantoaxial dislocation were included.Anterior atlantodental interval(AADI),clivo-axial angle(CXA)and the distance of the tip of dens to McRae Line(McRL)were measured preoperatively and at the last follow-up.The Japanese Orthopaedic Association(JOA)scoring system were used to characterize neurological function.Pearson correlation analysis was applied to analyse the relationship between JOA improvement rate and odontoid descent rate(ODR),change of AADI(△AADI)and CXA(△CXA).Results The average follow-up was(20.42±8.24)months.The preoperative JOA was(11.21±2.62),and JOA at follow-up was(14.53±2.19).The improvement rate of JOA was(58.75±24.43)%.Significant relationship between JOA improvement rate and ODR was found(R=0.88,P<0.05).No significant relationship was found between JOA improvement rate and△AADI(R=0.07,P=0.77)and△CXA(R=-0.04,P=0.98).Conclusion The surgical efficacy of foramen magnum decompression in basilar invagination with irreducible atlantoaxial dislocationis mainly depended on odontoid descent rate.When odonotoid decended to some degree,the surgical efficacy of foramen magnum decompression is optimum.