本文選題：枕頸畸形 + 口咽入路��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]回顧分析難復(fù)性復(fù)雜枕頸畸形病例,探討經(jīng)口咽寰樞椎松解復(fù)位后路枕骨大孔擴(kuò)大減壓枕頸固定融合術(shù)治療復(fù)雜枕頸畸形的臨床療效。[方法]回顧性分析2012年1月至2015年6月我科共收治并隨訪57例伴難復(fù)性寰樞脫位的復(fù)雜枕頸畸形患者的臨床資料。采用持續(xù)顱骨牽引下經(jīng)口咽寰樞椎松解復(fù)位+后路寰椎后弓切除枕骨大孔擴(kuò)大減壓枕頸固定植骨融合術(shù)治療此類畸形,術(shù)前、術(shù)后1月、3月、6月及12月隨訪時(shí)行JOA、VAS、NDI評分和頸椎X線、CT、MR檢查,并測量齒狀突超過Chamberlain線距離、延髓脊髓角(CMA)、寰齒前間隙(ADI)、枕大孔正中有效矢狀徑,所有患者根據(jù)手術(shù)前后JOA、VAS、NDI評分和測量影像學(xué)相關(guān)徑線評價(jià)臨床療效。[結(jié)果]平均手術(shù)時(shí)間5.3小時(shí),術(shù)中出血量62～220ml(146±37ml),術(shù)中置釘良好,未出現(xiàn)椎動(dòng)脈損傷和脊髓損傷加重,術(shù)后鼻飼3～7天,2周出院。術(shù)后無口咽部感染病例,枕頸部感染2例,經(jīng)清創(chuàng)VSD負(fù)壓吸引后均治愈。術(shù)前 JOA 評分 6～12 分(8.281 ± 1.688),VAS 評分 0～7 分(3.158± 1.320),NDI評分8～40分(28.088±7.422),分別與術(shù)后12月JOA評分10～17分(15.228± 1.389),VAS 評分 0～4 分(1.316±0.929),NDI 評分 5～19 分(12.702±2.732),比較差異均有統(tǒng)計(jì)學(xué)意義(t值分別為-30.207,24.823,23.353,P0.05)。術(shù)后復(fù)查影像學(xué)檢查示內(nèi)固定穩(wěn)定,植入骨塊達(dá)骨性融合,術(shù)后齒狀突超過腭枕線距離-10.00～6.90 mm(3.956mm±2.453),CMA 137.00～159.50°(147.991±5.418°),ADI 值 1.70～5.80mm(3.640±0.947mm),枕大孔正中有效矢狀徑25.70～32.90mm(29.918±1.792mm),軸位脊髓空洞最大直徑0～5.32mm(1.720±1.316),分別與術(shù)前齒狀突超過腭枕線(Chamberlain線)距離5.30～16.70mm(11.149±2.604),CMA 109.00～129.80°(120.774±5.859°),ADI 值 5.30～9.10mm(7.205±1.008mm),枕大孔正中有效矢狀徑 6.00～18.80mm(13.419±3.374mm),軸位脊髓空洞最大直徑 2.37～9.42mm(6.727±1.977),比較差異均有統(tǒng)計(jì)學(xué)意義(t值分別為35.167,-163.512,189.485,-76.191,11.263,P0.05)。[結(jié)論]難復(fù)性復(fù)雜枕頸畸形采用經(jīng)口咽寰樞椎松解復(fù)位后路枕骨大孔擴(kuò)大減壓枕頸固定融合術(shù)治療,可使齒狀突明顯下移,糾正寰樞脫位,解除脊髓壓迫,療效滿意。
[Abstract]:[Objective] to review and analyze the cases of complex complex occipital and cervical malformation, and to explore the clinical effect of the occipital cervical fixation with enlarged decompression and occipital fixation of occipital occipital through oropharyngeal atlantoaxial reduction and reduction. [Methods] a retrospective analysis of 57 cases of complex occipital neck with difficult atlantoaxial dislocation in our department from January 2012 to June 2015 was reviewed. The clinical data of the malformed patients. The JOA, VAS, NDI, and cervical X-ray, CT, MR examination, and the odontoid process exceeded Chamb before the operation were followed up in January, March, June and December. Erlain line distance, medulla oblongata angle (CMA), anterior atlantoodontoid space (ADI), the effective sagittal diameter of the occipital foramen, all patients were evaluated according to the JOA, VAS, NDI score and radiographic correlation diameter before and after the operation. [results] the average operation time was 5.3 hours, the amount of bleeding in the operation was 62 to 220ml (146 + 37ml), the intraoperative nailing was good and no vertebral artery loss appeared. The injuries and spinal cord injuries were aggravated, and the postoperative nasal feeding was 3~7 days and 2 weeks after operation. There were no pharynx infection cases and 2 cases of occipital and cervical infection after operation. After debridement VSD negative pressure, the preoperative JOA score was 6~12 points (8.281 + 1.688), VAS score was 0~7 (3.158 + 1.320), and NDI score was 8~40 (28.088 + 7.422), respectively, and JOA score 10~17 in December after the operation, respectively. (15.228 + 1.389), VAS score was 0~4 (1.316 + 0.929), NDI score was 5~19 (12.702 + 2.732), and the difference was statistically significant (t value was -30.207,24.823,23.353, P0.05). After operation, the imaging examination showed that the internal fixation was stable, the bone mass was implanted to the bone fusion, and the odontoid process exceeded the palatine occipital distance -10.00 to 6.90 mm (3.956mm) after the operation. + 2.453), CMA 137 ~ 159.50 (147.991 + 5.418 degrees), ADI value 1.70 ~ 5.80mm (3.640 + 0.947mm), the effective sagittal diameter of the occipital foramen was 25.70 to 32.90mm (29.918 + 1.792mm), and the maximum diameter of the cavities of the axial spinal cord was 0 to 5.32mm (1.720 + 1.316), and the distance between the anterior teeth and the palatine occipital line (Chamberlain line) was 5.30 to 16.70mm (CMA), CMA, respectively, CMA. 109 to 129.80 degrees (120.774 + 5.859 degrees), ADI value 5.30 ~ 9.10mm (7.205 + 1.008mm), the effective sagittal diameter of the occipital foramen was 6 to 18.80mm (13.419 + 3.374mm), and the maximum diameter of the cavities of the axial spinal cord was 2.37 to 9.42mm (6.727 + 1.977). The difference was statistically significant (t value was 35.167, -163.512189.485, -76.191,11.263, P0.05). [Conclusion] The complex and complex occipital neck malformation is treated with atlantoaxial loosening and reduction of occipital occipital cervical fixation with enlarged decompression of occipital occipital and posterior occipital cervical fusion, which can make odontoid process descend obviously, correct atlantoaxial dislocation and relieve spinal cord compression, and the curative effect is satisfactory.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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