Abstract:

Objective: In this study, a novel sliding-traction head holder was independently loped, and its pplication icacy in surger es for cr niovertebral junc ion abnorma ties was evaluated. Methods: A retrospective analysis was performed on 20 patients with congenital basilar invagination diagnosed and treated at Sanbo Brain Hospital, Capital Medical University from May 2022 to May 2024. Basilar invagination was classified into type Goel A patients (n=12) and type Goel B patients (n=8) according to the presence or absence of atlantoaxial dislocation. All patients underwent posterior facet distraction and fusion (PFDF) under traction of the novel sliding-traction head holder. The operation time, intraoperative blood loss, and postoperative complications were recorded. The imaging indexes (atlanto-dental interval, the distance from the odontoid tip to Chamberlain's line, clivus-pivot angle, and medulla oblongata-spinal cord angle) were recorded. The function impairment was assessed by Japanese Orthopedic Association (JOA). Results: Compared with preoperatively, the clivus-pivot angle (t=-3.499, P=0.006; t=-4.249, P=0.004) and the medulla oblongata-spinal cord angle (t=-6.480, P=0.000; t=-6.134, P=0.000) were significantly increased in type Goel A and type Goel B patients, the atlanto-dental interval (Z=-3.018, P=0.003) in type Goel A patients and the distance from the odontoid tip to Chamberlain's line (Z=-2.485, P=0.013; Z=-1.995, P=0.050) in type Goel A and type Goel B patients were significantly reduced. All patients showed significant improvement in JOA score (Z=-4.389, P=0.000). At one week and 3 months after surgery, there was no implant displacement in the craniocervical junction reconstructed by MRI and CT, and no serious complications such as aggravated neurological dysfunction, secondary revision and postoperative infection occurred. Conclusions: The application of the sliding-traction head holder in surgery for the cranio-cervical junction area exhibits high safety and effectiveness. The stability of the head and the precise adjustment of traction force during the operation can reduce the risk of complications. Demonstrating significant therapeutic effects in the surgical treatment of patients with congenital basilar invagination.

Key words: Atlanto-axial joint, Joint dislocations, Atlanto-occipital joint, Congenital abnormalities, Spinal fusion

摘要：

目的: 观察自主研发的新型滑轨式牵引头架在颅颈交界区畸形手术中的应用效果。方法: 回顾分析2022年5月至2024年5月首都医科大学三博脑科医院收治的20例先天性颅底凹陷症患者应用新型滑轨式牵引头架的情况。Goel A型（合并寰枢关节脱位）12例、Goel B型（不合并寰枢关节脱位）8例，均于滑轨式牵引头架牵引下行后路寰枢关节间撑开复位融合术，以手术相关指标（手术时间、术中出血量及术后并发症）以及影像学指标（寰齿间距、齿状突上缘至钱氏线距离、正中矢状位斜坡枢椎角及延髓脊髓角）和神经功能改善程度[日本骨科协会评分（JOA）]作为疗效评价标准。结果: 与术前相比，术后7 d Goel A型和Goel B型患者斜坡枢椎角（t=-3.499，P=0.006；t=-4.249，P=0.004）和延髓脊髓角（t=-6.480，P=0.000；t=-6.134，P=0.000）均增大，Goel A型患者寰齿间距（Z=-3.018，P=0.003）、Goel A型和Goel B型患者齿状突上缘至钱氏线距离（Z=-2.485，P=0.013；Z=-1.995，P=0.050）均减小；术后3个月JOA评分均较术前增加（Z=-4.389，P=0.000）；术后7 d和3个月时颅颈交界区CT三维重建及MRI未见一例发生植入物移位，亦无神经功能障碍加重、二次翻修手术、术后感染等严重并发症发生。结论: 滑轨式牵引头架在颅颈交界区畸形手术中安全可靠，术中可维持颅骨稳定、牵引力精确，从而降低并发症风险，在先天性颅底凹陷症患者的手术中展现出良好的应用前景。

关键词: 寰枢关节, 关节脱位, 寰枕关节, 先天畸形, 脊柱融合术