PDF(Pubmed)
Abstract：
OBJECTIVE: The surgical management of basilar invagination without atlantoaxial dislocation (type B basilar invagination) remains controversial. Hence, we have reported the use of posterior intra-articular C1-2 facet distraction, fixation, and cantilever technique versus foramen magnum decompression in treating type B basilar invagination as well as the results and surgical indications for this procedure.
METHODS: This was a single-center retrospective cohort study. Fifty-four patients who underwent intra-articular distraction, fixation, and cantilever reduction (experimental group) and foramen magnum decompression (control group) were enrolled in this study. Distance from odontoid tip to Chamberlain\'s line, clivus-canal angle, cervicomedullary angle, craniovertebral junction (CVJ) triangle area, width of subarachnoid space and syrinx were used for radiographic assessment. Japanese Orthopedic Association (JOA) scores and 12-item Short Form health survey (SF-12) scores were used for clinical assessment.
RESULTS: All patients in the experimental group had a better reduction of basilar invagination and better relief of pressure on nerves. JOA scores and SF-12 scores also had better improvements in the experimental group postoperation. SF-12 score improvement was associated with preoperative CVJ triangle area (Pearson index, 0.515; p = 0.004), cutoff value of 2.00 cm2 indicating the surgical indication of our technique. No severe complications or infections occurred.
CONCLUSIONS: Posterior intra-articular C1-2 facet distraction, fixation, and cantilever reduction technique is an effective treatment for type B basilar invagination. As various factors involved, other treatment strategies should also be investigated.
METHODS: This was a single-center retrospective cohort study. Fifty-four patients who underwent intra-articular distraction, fixation, and cantilever reduction (experimental group) and foramen magnum decompression (control group) were enrolled in this study. Distance from odontoid tip to Chamberlain\'s line, clivus-canal angle, cervicomedullary angle, craniovertebral junction (CVJ) triangle area, width of subarachnoid space and syrinx were used for radiographic assessment. Japanese Orthopedic Association (JOA) scores and 12-item Short Form health survey (SF-12) scores were used for clinical assessment.
RESULTS: All patients in the experimental group had a better reduction of basilar invagination and better relief of pressure on nerves. JOA scores and SF-12 scores also had better improvements in the experimental group postoperation. SF-12 score improvement was associated with preoperative CVJ triangle area (Pearson index, 0.515; p = 0.004), cutoff value of 2.00 cm2 indicating the surgical indication of our technique. No severe complications or infections occurred.
CONCLUSIONS: Posterior intra-articular C1-2 facet distraction, fixation, and cantilever reduction technique is an effective treatment for type B basilar invagination. As various factors involved, other treatment strategies should also be investigated.
摘要：
目的：无寰枢关节脱位（B型基底内陷）的基底内陷的手术治疗仍存在争议。因此，我们已经报道了使用后关节内C1-2小平面牵引，固定,悬臂技术与大孔减压治疗B型基底内陷的疗效和手术指征。
方法：这是一项单中心回顾性队列研究。54例接受关节内牵引的患者，固定,悬臂复位（实验组）和大孔减压（对照组）。从齿状突尖端到张伯伦线的距离，clivus-canalangle,颈髓角,颅骨交界处（CVJ）三角形区域，蛛网膜下腔和syrinx的宽度用于影像学评估。使用日本骨科协会（JOA）评分和12项简短形式健康调查（SF-12）评分进行临床评估。
结果：实验组所有患者的基底内陷减少较好，神经压力减轻较好。实验组术后JOA评分和SF-12评分也有较好的改善。SF-12评分改善与术前CVJ三角形面积相关(Pearson指数，0.515；p=0.004），截断值为2.00cm2，表明我们技术的手术指征。无严重并发症及感染发生。
结论：后关节内C1-2小平面牵引，固定,悬臂复位技术是治疗B型基底内陷的有效方法。由于所涉及的各种因素，还应研究其他治疗策略。
方法：这是一项单中心回顾性队列研究。54例接受关节内牵引的患者，固定,悬臂复位（实验组）和大孔减压（对照组）。从齿状突尖端到张伯伦线的距离，clivus-canalangle,颈髓角,颅骨交界处（CVJ）三角形区域，蛛网膜下腔和syrinx的宽度用于影像学评估。使用日本骨科协会（JOA）评分和12项简短形式健康调查（SF-12）评分进行临床评估。
结果：实验组所有患者的基底内陷减少较好，神经压力减轻较好。实验组术后JOA评分和SF-12评分也有较好的改善。SF-12评分改善与术前CVJ三角形面积相关(Pearson指数，0.515；p=0.004），截断值为2.00cm2，表明我们技术的手术指征。无严重并发症及感染发生。
结论：后关节内C1-2小平面牵引，固定,悬臂复位技术是治疗B型基底内陷的有效方法。由于所涉及的各种因素，还应研究其他治疗策略。
