Department of Spine Surgery, Peking University Fourth Clinical Medical College, Beijing Jishuitan Hospital, Beijing, China.
Spine (Phila Pa 1976). 2013 Apr 15;38(8):642-9. doi: 10.1097/BRS.0b013e31827a330a.
Retrospective case series.
The aim of this study was to describe the clinical outcomes of cervical reduction and occipital-C2 transarticular (OCTA) fixation with an assistance of intraoperative 3-dimensional navigation system (ITNS) during the treatment of reducible occipitocervical instability (OCI) in patients with Klippel-Feil syndrome (KFS) with occipitalization of the atlas and fusion of C2-C3.
Patients with KFS have congenital fusions of at least 2 cervical segments and may gradually develop symptoms at the hypermobile articulations adjacent to the cervical synostosis. This is particularly common in patients with KFS with occipitalization of the atlas and C2-C3 fusion. These patients may be at risk for instability and neurological complications of the occipitocervical junction that require occipitocervical reconstruction and fusion. Numerous treatment techniques are available for this pathological condition. However, there has yet to be a study of reducible OCI, showing successful treatment with intraoperative reduction and posterior OCTA fixation using ITNS.
From 2006 to 2011, 9 patients with KFS with reducible OCI attributed to occipitalization of the atlas and C2-C3 fusion were surgically treated. After a limited foramen magnum decompression, reduction of the OCI was conducted by intraoperative cervical traction and extension, followed by OCTA fixation using a direct posterior approach and with the assistance of ITNS. The follow-up period ranged from 6 to 60 months (mean, 31 mo).
Good decompression and bone fusion were achieved in all the patients. The clinical symptoms had improved for all patients. There were no intraoperative or postoperative complications.
In patients with KFS with occipitalization of the atlas and C2-C3 fusion, manual cervical traction in tandem with cervical extension, followed by posterior OCTA fixation and fusion provides a safe, effective treatment of OCI and ventral brainstem impingement. IFTN is a feasible tool for monitoring cervical reduction and OCTA screw insertion in patients with KFS with this pathological condition.
回顾性病例系列研究。
本研究旨在描述使用术中三维导航系统（ITNS）辅助下进行颈椎复位和枕骨-枢椎经关节（OCTA）固定治疗 Klippel-Feil 综合征（KFS）伴寰椎枕化和 C2-C3 融合的可复位寰枕部不稳定（OCI）患者的临床结果。
KFS 患者至少有 2 个颈椎节段融合，并且可能在邻近颈椎融合的活动性关节处逐渐出现症状。这在伴有寰椎枕化和 C2-C3 融合的 KFS 患者中尤为常见。这些患者可能存在寰枕关节不稳定和神经并发症的风险，需要进行寰枕重建和融合。对于这种病理情况，有许多治疗技术。然而，目前还没有关于可复位 OCI 的研究，显示使用 ITNS 进行术中复位和后路 OCTA 固定可取得成功治疗。
2006 年至 2011 年，我们对 9 例 KFS 伴可复位 OCI 患者进行了手术治疗，这些患者归因于寰椎枕化和 C2-C3 融合。在进行了有限的颅后窝减压后，通过术中颈椎牵引和伸展来进行 OCI 的复位，然后通过直接后路入路和 ITNS 的辅助进行 OCTA 固定。随访时间为 6 至 60 个月（平均 31 个月）。
所有患者均获得了良好的减压和骨融合。所有患者的临床症状均得到改善。无术中或术后并发症。
对于伴有寰椎枕化和 C2-C3 融合的 KFS 患者，颈椎牵引联合颈椎伸展，然后进行后路 OCTA 固定和融合，为 OCI 和前脑下干压迫提供了一种安全、有效的治疗方法。ITNS 是监测伴有这种病理情况的 KFS 患者颈椎复位和 OCTA 螺钉插入的一种可行工具。
