经口齿状突切除联合后路枕颈融合治疗颅底凹陷畸形
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蒲军(1968-),男,主任医师,硕士研究生导师,研究方向:颅底肿瘤与脑血管病。E-mail:1371001307@qq.com。

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云南省应用基础研究(昆医联合专项)项目编号:2013FB163


Clinical application of transoral odontoidectomy combined with posterior occipitocervical fusion in treatment of basilar impression malformation
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    摘要:

    目的 探讨显微镜下经口齿状突切除联合枕颈融合治疗颅底凹陷畸形的方法、疗效以及并发症。方法 回顾性分析昆明医科大学第二附属医院神经外科从2012年9月至2017年5月收治的12例齿状突突压迫延髓及上颈髓腹侧病人的临床资料,其中单纯颅底凹陷1例,颅底凹陷伴Chiari畸形7例,颅底凹陷伴寰枕融合4例,12例患者均行经口齿状突切除联合枕颈植骨融合手术治疗,术后长期跟踪随访,根据影像学参考数值作统计学分析。结果 经过6月至2年的随访,术后症状明显缓解8例,肢体感觉无变化3例,1例2月后出现脑脊液漏,经过修补和皮瓣转移治愈,无1例患者出现伤口感染,同时测量每例患者术前及术后影像学上钱氏线,麦氏线,韦氏线,Klaus高度指数、延颈髓角及颅底角的影像学参数值变化,并将影像学数值进行统计学分析,结果提示达到显著统计学意义(P<0.01)。结论 经口齿状突切除术是治疗齿状突压迫延髓及上颈髓腹侧病变直接有效的手术方法,术中充分磨除齿状突和必要的固定能够促进患者的治愈,提高患者的生活质量。

    Abstract:

    Objective To investigate the method, clinical effect, and complications of transoral odontoidectomy combined with posterior occipitocervical fusion in the treatment of basilar impression malformation.Methods A retrospective analysis was performed for the clinical data of 12 patients with compression of the medulla oblongata and the ventral upper cervical cord by the odontoid process who were treated in Department of Neurosurgery in The Second Affiliated Hospital of Kunming Medical University from September 2012 to May 2017. Among these patients, one had simple basilar invagination, 7 had basilar invagination with Chiari malformation, and 4 had basilar invagination with atlanto-occipital fusion. Transoral odontoidectomy combined with posterior occipitocervical fusion was performed for all patients. The patients were followed up for a long time after surgery and a statistical analysis was performed for imaging parameters.Results After a follow-up of 6 months to 2 years, 8 patients achieved marked remission, 3 had no change in abnormal sensation of the limbs, and 1 experienced cerebrospinal fluid leak two months later and was cured by repair and transfer of skin flap. No patient experienced wound infection. The changes in imaging parameters, including Chamberlain line, McGregor line, Webster line, Klaus height index, medullocervical angle, and cranial base angle, after surgery were measured; a statistical analysis was performed for such imaging parameters, and the results indicated statistical significance (P<0.01).Conclusions Transoral odontoidectomy is a direct and effective surgical method for compression of the medulla oblongata and the ventral upper cervical cord by the odontoid process. Adequate grinding of the odontoid process and necessary fixation can promote healing of patients and improve their quality of life.

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周宣, 钟彩云, 高静, 蒲军456.经口齿状突切除联合后路枕颈融合治疗颅底凹陷畸形[J].国际神经病学神经外科学杂志,2017,44(6):634-637111ZHOU Xuan, ZHONG Cai-Tun, GAO Jing, PU Jun222. Clinical application of transoral odontoidectomy combined with posterior occipitocervical fusion in treatment of basilar impression malformation[J]. Journal of International Neurology and Neurosurgery,2017,44(6):634-637

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  • 收稿日期:2017-08-20
  • 最后修改日期:2017-11-07
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  • 在线发布日期: 2017-12-28
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