枕骨大孔减压结合Magerl＋Brooks手术治疗复杂枕颈部畸形的疗效评估

目的探讨枕骨大孔减压结合Magerl＋Brooks手术治疗复杂枕颈部畸形的临床疗效和应用价值。方法 21例复杂枕颈部畸形病例采用枕颈后路枕骨大孔减压治疗脊髓压迫症,同时采用Magerl＋Brooks手术、植骨融合重建枕颈稳定性。结果平均随访12个月,18例神经功能明显改善,3例轻度改善;全部病例得到植骨融合;共置入39枚Magerl螺钉,内固定位置好,无神经血管损伤的并发症。结论枕颈后路枕骨大孔减压（必要时切除寰椎后弓）能够改善复杂枕颈部畸形导致的脊髓压迫症;Magerl＋Brooks手术可以短节段重建枕寰枢稳定性,保证植骨融合;使用计算机导航技术可以准确置入Magerl螺钉,避免神经血管损伤的手术并发症。

Foramen magnum decrompression combined with Magerl and Brooks technique for the complicated occipitocervical malformation

Objective To evaluate the clinical outcome of complicated occipitocervical malformation treated by using foramen magnum decrompression combined with instrumentation of transarticular screws（Magerl technique） and sublaminar cabling（Brooks technique）.Methods Twenty-one cases with complicated occipitocervical malformation were studied retrospectively.All cases were treated by using foramen magnum decrompression combined with Magerl and Brooks instrumentation to alleviate myelopathy and restore the occipitocervical stability.Results All patients were followed up for averaged 12 months.The neurological function improved significantly in 18 cases,moderately in 3 cases.Solid fusion was achieved in all cases.Totally 39 transarticular screws were inserted without neurovascular complications.Conclusion Foramen magnum decompression,sometimes with resection of the posterior arch of the atlas,may alleviate the myelopathy caused by complicated occipitocervical malformation.Transarticular screws（Magerl technique） combined with sublaminar cabling（Brooks technique） may restore the stability of occipito-atlanto-axial complex in a short segment construct.The transarticular screws may be inserted safely with computer assited navigation system with avoiding neurovascular complications.