目的:颅骨交界处(CVJ)提出了复杂的解剖学挑战。在严重或不可还原的畸形中,可能会出现复位丢失和固定失败等并发症,需要进行翻修手术。后小关节牵引融合(PFDF)技术,为修订提供了一个唯一的后验方法。因此,我们描绘了不同的修订方案,提出手术策略和技术细节,以提高结果和降低风险,从而丰富了神经外科界的曲目。
方法:这是一项回顾性队列研究,分析了宣武医院的患者数据,从2017年到2023年。所有患者均有CVJ畸形的手术治疗史,并经历了失败或减少的损失。从齿状突尖端到张伯伦线(DCL)的距离,寰枢椎间隔(ADI),clivus-canalangle,颈髓角,蛛网膜下腔的宽度,CVJ区域,和syrinx的宽度用于影像学评估。日本骨科协会(JOA)评分和SF-12评分用于临床评估。采用独立样本t检验。P<0.05的显著性水平表示统计学上显著的差异。
结果:我们分析了35例患者的数据。对于接受PFDF的患者,术后DCL,ADI,河顶-运河角明显改善。对于所有患者来说,术后颈髓角,蛛网膜下腔的宽度,CVJ区域,和syrinx的宽度都表现出显著的改善,表明神经压迫的缓解。所有患者在症状和临床评估方面均表现出显着改善。
结论:严重的寰枢关节锁定或韧带收缩是复位和固定失败的根本原因。前齿状突切除术适用于未复位位置的寰枢关节强骨融合的患者。PFDF技术对于不完全的寰枢椎骨融合患者是安全有效的。术前评估手术可行性和椎动脉状态可确保手术安全性和有效性。
OBJECTIVE: The craniovertebral junction (CVJ) presents intricate anatomical challenges. In severe or irreducible malformations, complications such as
reduction loss and fixation failure may occur, necessitating revision surgery. The posterior facet joint distraction and fusion (PFDF) technique, offers a solely posterior approach for revisions. Hence, we delineate varied revision scenarios, proposing surgical strategies and technical details to enhance outcomes and mitigate risks, thereby enriching the neurosurgical community\'s repertoire.
METHODS: This was a retrospective cohort study, analyzed patient data from Xuanwu Hospital, between 2017 to 2023. All patients had a history of surgical treatment for CVJ malformations, and experienced failure or loss of
reduction. The distance from the odontoid process tip to the Chamberlain\'s line (DCL), the atlantodental interval (ADI), clivus-canal angle, cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx were used for radiographic assessment. Japanese Orthopaedic Association (JOA) scores and SF-12 scores were used for clinical assessment. Independent sample t-tests were employed. A significance level of p < 0.05 indicates statistically significant differences.
RESULTS: We analyzed data from 35 patients. For patients who underwent PFDF, the postoperative DCL, ADI, and clivus-canal angle significantly improved. For all patients, the postoperative cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx all demonstrated significant improvement, indicating the relief of neural compression. All patients showed significant improvement in both symptoms and clinical assessments.
CONCLUSIONS: Severe atlantoaxial joint locking or ligament contracting are the fundamental cause of
reduction and fixation failure. Anterior odontoidectomy is indicated for patients with robust bony fusion of the atlantoaxial joint in an unreduced position. The PFDF technique is safe and effective for patients with incomplete atlantoaxial bony fusion. Preoperative assessment of surgical feasibility and vertebral artery status ensures surgical safety and efficacy.