【摘要】 目的探讨在枕大孔区腹侧病变切除术中枕骨髁的磨除范围与术后颅颈部稳定性之间的关系。方法远外侧经髁入路治疗枕大孔区腹侧病变32例。术中磨除枕骨髁后1/3者(A组)13例,磨除枕骨髁后1/2者(B组)11例,磨除后2/3者(C组)7例,枕骨髁完整磨除者1例。所有病人术后均行颅颈部X线片检查,依据Abe不稳定指标(Ⅱ)对病人颅颈部稳定性进行分级。结果A组13例颅颈部均稳定(100%);B组10例稳定(90.9%),1例稳定性差;C组7例均稳定性差,并有脊髓受压症状。A、B组颅颈部稳定率明显高于C组(P<0.01)。结论枕骨髁的磨除范围应限于其后内侧1/3至1/2,这样既可以充分显露手术视野,又不影响术后颅颈部的自然稳定性。当磨除范围达到枕骨髁后内侧2/3时,可明显影响术后颅颈部自然稳定性,应尽可能行颈枕融合术。更多还原

【Abstract】 Objective To explore the relationship between the size of the excised occipital condyle and the postoperative stability of atlanto-occipital joint in the patients with ventral lesions of foramina magnum. Methods The surgery through far lateral transcondylar approach was performed in 32 patients with ventral lesions of foramina magnum. The posterior 1/3 of the occipital condyle was excised in 13 patients (group A), posterior 1/2 of the occipital condyle was excised in 11 (group B), the posterior 2/3 of the occipital condyle were excised in 7 (group C), and all the occipital condyle was excised in 1. The postoperative stability of the atlanto-occipital joints was graded by Abe Guide Line, in all the patients, in whom X-ray examinations of atlanto-occipital joints were performed. Results According to Abe Guide Line all the patients in group A had stable atlahto-occipital joints, in group B 10 had stable atlahto-occipital joints and 1 unstable, and in group C all the patients had unstable atlanto-occipital joints and clinical compressive symptoms of the spinal cords after the operation. There was insignificant difference in the stability rate of the atlahto-occipital joints between both groups A and B (P>0.05). The stability rates of the atlahto-occipital joints were significantly higher in groups A and B than that in group C (P<0.05). Conclusions The size of the excised occipital condyle should be limited within from 1/3 to 1/2 of its posterointerior aspect. The excised size from 1/3 to 1/2 of the occipital condyle can provide enough exposure for the surgery, and also can keep the natural stability of atlanto-occipital joint after the operation.更多还原