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单纯寰枢椎固定治疗合并寰枕融合的Chiari畸形

Treatment of single one-stage posterior atlantoaxial fixation in Chiari malformation

摘要:

目的 探讨采用单纯后路颈寰枢椎钉棒内固定治疗合并寰枕融合但无寰枢椎脱位的Chiari畸形的临床疗效.方法 回顾性分析2014年1月至2015年10月解放军总医院神经外科收治的23例合并寰枕融合但无寰枢椎脱位的Chiari畸形患者资料,男性8例,女性15例;年龄11~57岁,平均(35.5±10.5)岁.采用后路颈寰枢椎钉棒内固定加自体植骨融合手术治疗,记录患者手术时间,术中出血量;采用日本骨科协会(JOA)脊髓功能评分和Odom评级评估患者临床症状的改善情况,采用MRI测量评价小脑扁桃体下疝改善程度.手术前后JOA评分和下疝小脑扁桃体长度的比较采用配对t检验.结果 23例患者均成功置入螺钉,手术时间(172.7±19.9)min,术中出血量(153.9±49.3)ml,无椎动脉损伤、脑脊液漏发生.与术前相比,末次随访时JOA评分增加(13.7±1.6比11.5±1.4),差异有统计学意义(t=13.386, P<0.01);下疝小脑扁桃体长度降低[(0.8±0.6)cm比(1.9±0.6)cm],差异有统计学意义(t=17.995, P<0.01).术后Odom评级:优6例(26.1%),良13例(56.5%),可4例(17.4%).所有内固定位置满意,随访期间无固定器械松动,无断钉断棒现象,骨融合率达100%.23例患者均获得随访,随访时间6~23个月,平均(10.5±3.2)个月;1例于随访期间出现内固定物相关不适,骨性融合后于术后4个月再次入院行内固定物取出术后症状缓解;其余22例未见新发神经功能症状.结论 对于合并寰枕融合无寰枢椎脱位的Chiari畸形,单纯后路内固定术治疗可有效改善小脑扁桃体下疝.

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abstracts:

Objective To explore the effects of surgical technique of single one-stage posterior C1-2 screw rod fixation of Chiari malformation (CM) associated with occipitalization and without atlantoaxial dislocation.Methods A total of 23 patients with CM treated between January 2014 and October 2015 in Department of Neurosurgery of Chinese People′s Liberation Army General Hospital were retrospective reviewed.All of them were diagnosis with CM associated with occipitalization and without atlantoaxial dislocation, including 8 males and 15 females, aging from 11 to 57 years (mean (35.5±10.52) years).Single one-stage posterior C1-2 screw rod fixation with bone grafting fusion was performed.Operation time and intraoperative blood loss were recorded.Japanese Orthopaedic Association (JOA) scores and Odom rating were used to evaluate the clinical effects at pre-and post-operative.Regression of the cerebellar tonsillar was measured by MRI.The results were analyzed by paired samples t test.Results Twenty-three patients were implanted screws successfully, the vertebral artery injury and cerebrospinal fluid leakage were not found.The mean operation time was (172.7±19.9) minutes, the intraoperative blood loss was (153.9±49.3) ml.Compared to preoperative, the JOA score increased (13.7±1.6 vs.11.5±1.4) and the tonsillar herniation decreased ((0.8±0.6)cm vs.(1.9±0.6) cm) in the last follow-up, there were statistical difference (t=13.386, P<0.01;t=17.995, P<0.01).The results of the postoperative Odom grading were as follows: 6 cases were perfect (26.1%), 13 cases were good (56.5%), 4 cases were moderate (17.4%) and no case was poor.No signs of instrument loosen or screw broken was noticed.100% bony fusion rate was achieved.The follow-up time was 6 to 23 months (mean (10.5±3.2) months).One case developed internal fixator related discomfort, the symptom was relieved by internal fixator removal surgery performed 4 months after the operation when osseous fusion had already been achieved.No new neurologic symptoms were observed in other 22 patients.Conclusions The results of the study substantiates the effectiveness of single one-stage posterior fixation strategy for CM, which is associated with occipitalization and without atlantoaxial dislocation.This technique could be an alternative choice for this type of CM.

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