多层螺旋CT对成人颅底凹陷症手术前后骨性后颅凹的测量价值

目的 探讨MSCT对评价成人颅底凹陷症手术前、后骨性后颅凹的变化及其手术疗效的价值.方法 搜集31例成人颅底凹陷症患者手术前、后的MSCT 三维重组图像,根据有无寰枢关节脱位分成A、B组,A组11例、B组20例,分别测量枕齿间隙(BDI)、寰齿前间隙(ADI)、椎管储备间隙(SAC)、斜坡-椎管角(CCA)、Klaus高度指数(HI)、腭枕线(CBL),比较分析各指标手术前、后的变化及其与手术疗效的相关性.采用配对样本t检验、Spearman直线相关分析进行统计学分析.结果 A组手术前后BDI、ADI、SAC、CCA、HI、CBL分别为12.6、8.3 mm,4.5、3.3 mm,18.2、20.8 mm,138.3°、150.4°,28.7、43.4 mm,6.3、3.3 mm,术前日本矫形外科学会(JOA)评分10分,术后14分,差异均有统计学意义(t值分别为5.603、2.323、3.124、5.531、4.278、2.375,P值均＜0.05)；手术有效(优良)7例,稳定(可)4例,手术前、后JOA评分与BDI、ADI、SAC、CCA、HI、CBL显著相关(r值分别为-0.667、-0.673,-0.571、-0.619,0.642、0.513,0.525、0.558,0.587、0.511,- 0.532、- 0.596;P值均＜0.05).B组手术前后SAC、CCA、CBL分别为18.3、19.6mm,146.8°、150.2°,2.7、1.8mm,术前JOA评分11分,术后16分,差异均有统计学意义(t值分别为5.359、4.126、0.769,P值均＜0.05)；BDI、ADI、HI分别为7.2、6.6mm,2.4、2.1mm,39.3、41.5mm,差异均无统计学意义(t值分别为1.482、2.374、0.153,P值均＞0.05).手术有效(优良)14例,稳定(可)6例.手术前、后JOA评分与BDI、ADI、HI均无相关性(r值分别为0.341、0.387,0.154、0.182,0.192、0.167,P值均＞0.05)；与CBL、SAC和CCA显著相关(r值分别为- 0.756、- 0.728,0.651、0.672,0.726、0.695,P值均＜0.05).结论 MSCT测量有助于颅底凹陷症手术前、后骨性后颅凹解剖结构变化的比较分析和手术疗效的综合评价.

Evaluation of osteal posterior cranial fossa in adults by multi-slice CT measurements before and after operation in basilar invagination patients

Objective To evaluate the clinical effect of MSCT measurements in the pre- and postoperational osteal posterior cranial fossa for the adult patients of basilar invagination.Methods We reviewed the images of a cohort of 31 adult patients with basilar invagination,which were treated by surgical operation.According to the presence of atlantoaxial dislocation,the patients were divided into groups A and B.The basion-dens interval (BDI),atlanto-dental interval (ADI),space available of the spinal cord ( SAC),clivus-canal angle( CCA),Highly index( HI),and Chamberlian line(CBL) of the posterior cranial fossa were obtained in all the patients.Independent-sample Student's t test was used to compare the differences between groups A and groups B.Spearman correlations were analyzed between CT measurement data and effects of operations.Results In Group A,the BDI,ADI,SAC,CCA,HI,CBL before and after surgery were 12.6 mm,8.3 mm,4.5 mm,3.3 mm;18.2 mm,20.8 mm,138.3°,150.4°,28.7 mm,43.4 mm,6.3 mm,3.3 mm respectively.There were significant differences ( t = 5.603,2.323,3.124,5.531,4.278 and 2.375,respectively,P ＜0.05 ).Preoperative JOA score in groups A was 10 points,and was 14 points after surgery.There was significant difference between the JOA scores before and after surgery ( t = 3.526,P ＜ 0.05 ).There were 7 effective cases and 4 stable cases after surgery in group A.Before and after surgery,JOA score and BDI,ADI,SAC,CCA,HI,CBL were significantly correlated( r = -0.667,- 0.673 ; - 0.571,- 0.619 ; 0.642,0.513 ; 0.525,0.558 ; 0.587,0.511 ; - 0.532,- 0.596,respectively,P＜0.05).The SAC,CCA,and CBL before and after surgery in group B were 18.3 mm,19.6 mm,146.8°,150.2°,2.7 mm,1.8 mm.The difference was statistically significant after operation ( t = 5.359,4.126,0.769,P ＜0.05).The BDI,ADI,and HI before and after surgery in group B were 7.2 mm,6.6 mm,2.4 mm,2.1 mm,39.3 mm,41.5 mm.And there were no significant differences (t = 1.482,2.374,0.153,P＞0.05).The preoperative JOA score in groups B was 11 points,and the postoperative score was 16 points.JOA scores before and after surgery were significantly different (t =2.874,P ＜0.05).There were 14 effective cases and 6 stable cases after operation in group B.The JOA score before and after surgery and BDI,ADI,and HI had no correlation (r =0.341,0.387;0.154,0.182; 0.192,0.167,P ＞0.05),and CBL,SAC and CCA were correlated (r = -0.756,-0.728;0.651,0.672; 0.726,0.695,P ＜0.05).Conclusion MSCT measurements for basilar invagination before and after surgery are helpful for understanding changes of osteal posterior fossa anatomy and comprehensive evaluation of surgical treatment.