Zhang B Y, Duan W R, Liu Z L, Guan J, Zhang C, Wang Z W, Jian F Z, Chen Z
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Zhonghua Wai Ke Za Zhi. 2022 Sep 1;60(9):824-830. doi: 10.3760/cma.j.cn112139-20220228-00086.
To examine the effect of posterior atlanto-axial intraarticular distraction technique as revision surgery for failed posterior fossa decompression in patients with basilar invagination(BI) and atlanto-axial dislocation(AAD). The clinical data of 13 cases of AAD accompanied with BI treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical University were retrospectively analyzed. There were 3 males and 10 females,aged (42.6±9.5) years (range:30 to 63 years). All cases had assimilation of atlas and once underwent posterior fossa decompression. Anterior tissue was released through posterior approach followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique. The clinical results were evaluated using Japanese Orthopedic Association scale(JOA) and the main radiological measurements including atlantodental interval (ADI), the distance of odontoid tip above Chamberlain line(DCL),clivus-canal angle(CCA) and the length of syrinx were collected. Paired sample test was used to compared the data before and after operation. All patients underwent surgery successfully, the mean surgical time was (187.7±47.4) minutes (range from 116 to 261 minutes). Twenty occipital condyle screws, 26 C2 pedicle screws and 3 occipital plates were implanted. Clinical symptoms improved in all patients. Twelve patients had complete reduction of basilar invagination and atlanto-axial dislocation, 1 achieved near completely reduction of basilar invagination. The postoperative ADI, DCL and CCA significantly improved((4.3±1.1) mm (1.8±0.8) mm, (11.7±5.0) mm (6.4±2.8) mm, (142.4±7.9)° (133.3±7.9)°, all <0.01).There were 5 cases with syringomyelia before surgery, and shrinkage of syrinx was observed 1 week after surgery in all cases. Eight patients achieved bone fusion 3 months after surgery, all patients achieved bone fusion 6 months after surgery. The JOA score increased from 12.8±2.3 before surgery to 14.8±1.3 one year after surgery, with statistically significant difference (=4.416, 0.01).No implant failure, spacer subsidence and infection were observed. In cases of failure posterior fossa decompression of basilar invagination and atlanto-axial dislocation, using posterior atlanto-axial intraarticular distraction and cantilever technique with cage implantation could achieve complete reduction and symptomatic relief.
探讨寰枢椎关节内撑开技术作为翻修手术治疗颅底凹陷症（BI）合并寰枢椎脱位（AAD）患者后颅窝减压失败的疗效。回顾性分析首都医科大学宣武医院神经外科收治的13例AAD合并BI患者的临床资料。其中男3例，女10例，年龄（42.6±9.5）岁（范围：30至63岁）。所有病例均有寰椎融合且均曾行后颅窝减压术。经后路松解前方组织，随后将椎间融合器植入关节突关节，并采用悬臂技术行枕颈固定。采用日本骨科协会评分（JOA）评估临床疗效，并收集主要影像学测量指标，包括寰齿间距（ADI）、齿突尖高于Chamberlain线的距离（DCL）、斜坡-椎管角（CCA）及空洞长度。采用配对样本检验比较手术前后的数据。所有患者手术均成功，平均手术时间为（187.7±47.4）分钟（范围：116至261分钟）。共植入20枚枕髁螺钉、26枚C2椎弓根螺钉和3块枕骨板。所有患者临床症状均改善。12例患者颅底凹陷症和寰枢椎脱位完全复位，1例颅底凹陷症近乎完全复位。术后ADI、DCL和CCA均显著改善（（4.3±1.1）mm比（1.8±0.8）mm，（11.7±5.0）mm比（6.4±2.8）mm，（142.4±7.9）°比（133.3±7.9）°，均P<0.01）。术前有5例合并脊髓空洞症，术后1周所有病例脊髓空洞均见缩小。8例患者术后3个月实现骨融合，所有患者术后6个月均实现骨融合。JOA评分从术前的12.8±2.3提高至术后1年的14.8±1.3，差异有统计学意义（t=4.416，P=0.01）。未观察到内固定失败、椎间融合器下沉及感染。对于颅底凹陷症和寰枢椎脱位后颅窝减压失败的病例，采用寰枢椎关节内撑开及悬臂技术并植入椎间融合器可实现完全复位并缓解症状。
