上颈椎畸形不稳定后路手术中斜坡-枢椎角与疗效的相关性研究

 目的回顾性分析上颈椎畸形不稳定患者后路手术复位固定前后的斜坡-枢椎角（clivus-axial angle,CAA）改善情况和临床效果。方法自2004年4月到2014年8月,按纳入及排除标准共32例存在临床症状的上颈椎畸形不稳定患者纳入研究,其中1例再手术者未纳入统计。游离齿突10例,齿突发育不良5例,Klipple-Feil综合征4例,寰枢椎半脱位4例,寰枢椎不稳定4例,类风湿性关节炎伴寰枢椎半脱位1例,陈旧齿突骨折1例,齿突不连伴枕骨大孔狭窄症1例,颅底凹陷症并Klipple-Feil综合征1例。均采用颈椎后路手术复位固定植骨融合手术,通过对CAA的改善来解除脊髓的压迫。按术中是否减压分为两组：未减压组17例（男8例,女9例;年龄13~65岁,平均50.1岁）和减压组14例（男7例,女7例;年龄19~68岁,平均49.6岁）。手术前后测量CAA,观察其变化。临床疗效评价采用颈椎功能障碍指数（neck disability index, NDI）和Nurick脊髓功能评分。结果所有患者均得到随访,未减压组随访时间0.7~10.7年,平均2.9年;减压组随访时间0.3~5.5年,平均2.9年。未减压组与减压组术后CAA均明显改善,差异均有统计学意义,但组间比较差异均无统计学意义。未减压组和减压组患者术后NDI评分和Nurick脊髓功能评分较术前均明显降低,差异均有统计学意义。术后1例出现恶心、呕吐,1例出现小腿肌间隙血栓,1例出现面部肿胀视物模糊,1例出现椎管减压综合征,经对症处理后均好转。未出现椎动脉损伤、感染及内固定松动等严重并发症。结论对于上颈椎畸形不稳定患者术中改善CAA能够缓解脊髓受压引起的症状,颈部功能和脊髓功能得到明显改善。

Relationship between reconstruction of the clivo-axial angle and curative effect in posterior approach surgery for the treatment of upper cervical spine anomaly instability

ObjectiveThe aim of this study was to describe the clinical outcomes and improvement of clivo-axial angle (CAA) during the posterior approach surgery of upper cervical anomaly instability patients. MethodsAll of 32 patients with symptomatic upper cervical anomaly instability were followed up from 2004 Apr. to 2014 Aug. in which 1 patient was excluded because of reoperation. There were 10 patients with OS odontiodeum,5 with odontoid deformity, 4 with Klipple-Feil syndrome, 4 with atlantoaxial dislocation, 4 with atlantoaxial instability, 1 with rheumatoid arthritis, 1 with old odontoid fracture, 1 with OS odontoideum and foramen magnum stenosis, 1 with basilarinvagination and Klipple-Feil syndrome. They were all performed posterior reduction internal fixation and fusion, and then released spinal cord compression with the promotion of CAA. The patients were divided into two groups on the basis of decompression or not: non-decompression group 17 cases (male 8 cases, female 9 cases; age 13-65 years old, average 50.1 years old) and decompression group 14 cases (male 7 cases, female 7 cases; age 19-68 years old, average 49.6 years old). The CAA numbers were measured and compared. The clinic date was compared between preoperatively and postoperatively, which included Neck Disability Index and Nurick Classification System for Myelopathy. ResultsAll patients were followed up, the follow-up time of non-decompression group was 0.7-10.7 years, average 2.9 years; the follow-up time of compression group was 0.3-5.5 years, average 2.9 years. Analysis of CAA, NDI and Nurick score were performed with t-test. The postoperative CAA, NDI and Nurick score improved significantly compared to preoperative ones. There was no difference between non-decompression group and decompression group. One patient felt nausea and vomited, one got soleal vein thrombosis, one had a swelling face and blurring vision and one had decompression syndrome after operation, all of these were improved using respectively therapy. No such serious complications as injury to vertebral artery, infection or internal fixation loosening occurred. ConclusionNeck ability and spinal cord function was significantly improved through increasing CAA for the upper cervical anomaly instability patients underwent posterior reduction internal fixation and fusion.