颅底凹陷症合并寰枢椎脱位手术治疗体会(附8例报告)

目的 介绍8例颅底凹陷症合并寰枢椎脱位颈枕后路钉棒系统辅助下齿状突复位的技术要点及临床效果。方法 2010年1月至2013年5月收治颅底凹陷症合并寰枢椎脱位患者8例，所有患者都选用强生公司钉棒系统、Y型枕骨板和钛棒，其中行双侧C2椎弓根螺钉固定4例，行双侧C2椎弓根螺钉及双侧C3侧块螺钉固定3例，行右侧C2椎弓根螺钉、左侧C3侧块螺钉及双侧C4侧块螺钉固定1例。术前后均行X光片、CT扫描观察齿状突复位效果及螺钉位置, 通过比较术前术后钱氏线( CL)、寰椎齿突间隙(ADI)和延髓脊髓夹角(CMA), 评价手术疗效。结果 8例患者中手术后齿状突均达到不同程度的复位，CT复查螺钉位置理想，所有病例均形成良好骨性融合。随访2~40个月, 所有患者术前肢体麻木、无力等症状较术前明显好转，1例患者术后出现吞咽固体食物困难，对症治疗1月后好转。结论 颈枕后路钉棒植入并撑开技术可以有效地治疗颅底凹陷合并寰枢椎脱位，解除齿状突脱位导致的压迫症状。

Surgical treatment for atlantoaxial dislocation combined with craniovertebral junction region malformation(8 cases report)

Objective To evaluate the outcome of posterior screw-rod fixation system in surgical treatment of 8 cases of atlantoaxial dislocation combined with craniovertebral junction region malformation. Methods A retrospective study was performed in 8 patients (5 men and 3 women; aged 21-62 years; mean, 39 years) with atlantoaxial dislocation combined with craniovertebral junction region malformation from January 2010 to May 2013. The Screw rod system produced from Johnson & Johnson company was used in all of the patients. 4 patients underwent C2 pedicle screw fixation on both sides, 3 patients underwent C2 pedicle screw fixation combined with C3 lateral mass on both sides， and1 patient underwent C2 pedicle screw fixation on the right side， C3 lateral mass on the left side， and C4 pedicle screw fixation on both sides. The X-ray and CT scan were performed to evaluate the effect of odontoid restoration by comparing the CL, ADI and CMA. Results The 8 patients were followed up for 2-40 months, and all of them showed improved restoration of odontoid. Only 1 patient suffered from dysphagia after the surgery, who was cured after symptomatic treatment. Conclusion Posterior screw-rod fixation system is effective to treat the patients with atlantoaxial dislocation combined with craniovertebral junction region malformation.