1例经口咽入路齿状突磨除术治疗颅颈交界畸形患者的护理

颅颈交界区畸形常致延髓、高位颈髓受压，导致患者出现一系列临床症状，如四肢麻木无力、肌肉萎缩和呼吸困难。我科新近开展了经口咽人路显微直视减压术治疗颅颈交界畸形，术后取得满意疗效，现介绍如下。     

MRI选择性测量及诊断:颅颈交界区畸形

目的:探讨MR颅颈交界区畸形的影像学表现及其诊断价值.材料与方法:应用4种传统方法及后颅凹深度测量法,对22例颅颈交界区畸形患者的临床资料及MR图像进行回顾性对照分析.结果:对颅颈区畸形诊断阳性率:钱氏线、布加德角均达90.9％(20/22),麦克雷线达72.7％(16/22),寰齿间隙达45.5％(10/22),后颅凹深度达86.4％(19/22);颅底凹陷伴其它颅颈交界区畸形19例,依据Goel分型:A型9例,B型10例;其它颅颈交界区畸形3例(1例为特殊类型).结论:MRI是一种无创性检查手段,对颅颈交界区畸形的诊断敏感性高;5种测量方法简便易行,联合MR多方位图像,对颅颈交界畸形分类,为临床治疗提供详细影像学信息.     

经口咽前路松解后路枕颈融合内固定术治疗颅底凹陷症的手术配合

颅底凹陷症是一种颅颈交界区畸形,指枕骨大孔四周骨质内陷入颅腔,造成枕骨大孔狭窄,进而小脑、脑干及脊髓受压,通常合并颅颈交界区其他部位畸形,常导致颅后窝和上颈部椎管有效空间缩小,从而使患者出现一系列的临床表现[1]。     

经口咽入路行延髓-颈髓腹侧减压治疗颅颈交界区畸形85例的护理

本文总结2006-01—2008—12经口咽人路行延髓-颈髓腹侧减压治疗颅颈交界区畸形患者85例的护理,现报道如下。     

改进翻身法对先天性颅颈交界区畸形术后伤口愈合的影响

目的探讨改进翻身法对先天性颅颈交界区畸形术后伤口愈合的影响。方法82例先天性颅颈畸形采取后路植骨融合术的患者,采用不同翻身法分组对比进行分析。结果常规翻身组与改进组术后伤口顺利愈合率分别为95.1%和100%。结论改进翻身法能改善先天性颅颈交界区畸形术后伤口愈合情况。     

手术治疗寰枢椎脱位

目的：探讨采用经口咽入路显微外科治疗颅颈区腹侧畸形寰枢椎脱位的方法及疗效。方法：颅颈区腹侧畸形寰枢椎脱位15例，手术采用经口咽入路显微直视下切除齿状突、斜坡下部及增生的结缔组织，解除其对延髓、颈髓腹侧的压迫。结果：痊愈8例，好转7例，无手术死亡和感染。结论：经口咽入路显微直视减压术，是治疗延髓、颈髓腹侧受压的颅颈区畸形的首选方法，重视围手术期处理可预防术后并发症。     

经口咽入路显微手术治疗颅颈区畸形

目的：探讨采用经口咽入路显微外科治疗颅颈式腹侧畸形的方法及疗效。方法：颅颈区腹侧畸形6例，手术采用经口咽入路显微直视下切除齿状突，斜坡下部及增生的结缔组织，解除其对延髓，颈髓腹侧的压迫，结果：痊愈4例，好转2例，无手术死亡和感染，结论：经口咽入路显微直视减压术，是治疗延髓，颈髓腹侧受压的颅颈区畸形的首选方法，重视围手术期处理可预防术后并发症。     

经口咽入路齿状突磨除术的观察与护理

随着显微神经外科和功能神经外科的发展，经口咽入路治疗颅颈交界区病变的技术日趋成熟。寰枢椎脱位是较为常见的一种颅颈交界区的畸形，多为先天性，其机理主要是齿状突或G椎体后上缘从前方压迫延髓-颈髓。经口咽入路齿状突磨除术可有效地缓解其压迫。2003年1月-2005年8月，我科采取经口咽入路齿状突磨除治疗寰枢椎脱位45例，效果满意，现报道如下。     

颅颈交界区畸形经口咽入路齿状突唐除术的护理

颅颈交界区畸形有称枕骨大孔区畸形,多为先天性,其机理主要是齿状突或颈2椎体后缘从前向后压迫延髓、颈髓行成一系列球麻痹症状,采用传统后路减压的外科治疗方法治疗不仅无效,还可能因为延髓-颈髓移位,造成严重的后果.     

经口咽入路齿状突磨除术的观察与护理

随着显微神经外科和功能神经外科的发展,经口咽入路治疗颅颈交界区病变的技术日趋成熟。寰枢椎脱位是较为常见的一种颅颈交界区的畸形,多为先天性,其机理主要是齿状突或C2椎体后上缘从前方压迫延髓-颈髓。经口咽入路齿状突磨除术可有效地缓解其压迫[1]。2003年1月-2005年8月,我     

颅颈交界畸形外科治疗中辅助外固定支具的应用

目的探讨在颅颈交界畸形外科治疗中辅助外固定支具的选择和应用。方法回顾48例先天性颅颈交界畸形外科治疗中辅助外固定支具的应用,其中包括颈围、头环胸衣(Halo-vest)、胸骨-枕骨-下颔固定器(SOMI)3种颈部支具。结果后路内固定术后辅助外固定支具初选分别为费城式颈围(20例)、SOMI(16例)、头环胸衣(12例),应用效果优良率分别为80.0%、87.5%和91.7%。初选支具效果不满意者经更改支具后,最终在康复期应用的支具分别为费城式颈围16例、SOMI15例、头环胸衣17例35例(72.9%)获得了随访4个月以上,支具固定时间均超过3个月,满足所需术后支具外固定时间。结论颈围、头环胸衣、SOMI3种颈部支具在颅颈交界畸形外科治疗的围手术期和康复期的应用具有重要临床价值,需结合患者的病情特点和外科治疗不同阶段加以选择应用。     

The transoral surgical approach to craniovertebral pathology

The transoral approach is a surgical technique that can be used effectively in the treatment of anterior craniovertebral junction (CVJ) pathology. In this review, we outline the signs, symptoms, and diagnostic studies that identify the pathology and help to determine subsequent therapy. The transoral approach, preoperative and postoperative management problems, and potential complications of the procedure are reviewed. The nursing care of a patient with CVJ pathology is discussed.     

MR imaging of the craniovertebral junction

The rapid growth of MR imaging has brought a renewed interest in the craniovertebral junction. Many congenital and acquired lesions affect this region and compress the underlying cervicomedullary junction and cranial nerves. Basilar invagination, basilar impression, and cranial settling are readily assessed with MR imaging in the sagittal plane, and evaluation of this region on all cranial and cervical spine studies should become routine.     

Effects of sling-based manual therapy on cervicothoracic junction in patients with neck pain and forward head posture: A randomized clinical trial

ObjectiveThe purpose of this study was to investigate the effect of 4 weeks of sling-based manual therapy on the cervicothoracic junction (CTJ) area in patients with neck pain and forward head posture.DesignSingle-blind randomized controlled trial.SettingOutpatient, Chonbuk National University hospital, Republic of Korea.SubjectsA total of 22 participants with neck pain (Numeric Pain Rating Scale >3) and forward head posture (craniovertebral angle <51) were randomly assigned to a CTJ group or a control group (n = 11 each).InterventionIn the control group, joint mobilization and motor control training was applied for the upper cervical spine (C0–C1). The CTJ group applied the same intervention to the upper cervical spine and cervicothoracic junction (C7-T3).Main measuresNumeric pain rating scale and neck disability index, craniovertebral angle, active range of motion, and muscle activity were evaluated before and after 4 weeks of intervention.ResultThe CTJ group participants showed significant improvement in the craniovertebral angle and cervical extension range after the intervention than the control group (P = 0.025, P = 0.001). While both groups presented significant differences after the intervention regarding Numeric pain rating scale, neck disability index, and muscle activity (sternocleidomastoid and anterior scalene muscle), there were no statistically significant differences between the groups (P > 0.05).ConclusionOur results suggest that the CTJ and the upper cervical region in patients with neck pain and forward head posture represent an area which if approached by manual therapy, improves cervical mobility and posture.     

Magnetic resonance imaging of craniovertebral structures: clinical significance in cervicogenic headaches

This paper aims to investigate the relevance of morphological changes in the main stabilizing structures of the craniocervical junction in persons with cervicogenic headache (CEH). A case control study of 46 consecutive persons with CEH, 22 consecutive with headache attributed to whiplash associated headache (WLaH) and 19 consecutive persons with migraine. The criteria of the Cervicogenic Headache International Study Group (CHISG) were used for diagnosing CEH; otherwise the criteria of the International Classification of Headache Disorders (ICHD II) were applied. All participants had a clinical interview, and physical and neurological examination. Proton weighted magnetic resonance imaging (MRI) of the craniovertebral junction, and the alar and transverse ligaments were evaluated and blinded to clinical information. The MRI of the craniovertebral and the cervical junctions, the alar and transverse ligaments disclosed no significant differences between those with CEH, WLaH and or migraine. The site of CEH pain was not correlated with the site of signal intensity changes of the alar and transverse ligaments. In fact, very few had moderate or severe signal intensity changes in their ligaments. MRI shows no specific changes of cervical discs or craniovertebral ligaments in CEH.     

Developmental anomalies of the craniocervical junction and cervical spine

Developmental anomalies of the craniocervical junction and cervical spine are relatively common in childhood and are potentially dangerous because of instability, particularly in the context of trauma. It is important that the radiologist understands and identifies these anomalies to contribute to their proper management. This article reviews the common and important anomalies of the craniovertebral junction, cervical spinal column, and related craniospinal neuraxis.     

利用螺旋CT数据建立上颈椎三维有限元模型

目的：建立上颈椎三维有限元模型．以期应用于临床相关的生物力学实验研究。方法：通过对正常人的CT薄层扫描获得原始DICOM图像数据．采用CAD数据处理技术进行计算机三维重建．改良建立的模型导进ANSYS9．0软件进行计算机模拟仿真生物力学研究。结果：所建模型外观清晰逼真。几何相似性好。三维重建结构可以单独或联合显示。甚至可行结构的任意取舍，重建结构的任意径线及角度均可进行适时三维测量。结论：该技术为临床医生对枕颈交界区有限元三维模型的建立提供了一种便捷而精确的方法，对计算机分析及研究该模型局部结构在各种受力情况下的生物力学表现创造条件。     

内镜辅助经颈前咽后入路治疗19例颅颈交界区病变的护理

总结了19例颅颈交界区病变患者在内镜辅助下经高位颈前咽后入路完成手术的围手术期护理。护理重点包括:术前针对性地做好患者心理护理及口腔准备,术后保持颈椎的稳定性,监测患者的生命体征和血氧饱和度的变化,观察脊髓和神经功能,加强呼吸道护理,注重切口敷料及切口引流管的护理,防范术后并发症的发生并及时采取有效的护理措施。本组均获得满意疗效,术前神经功能日本骨科协会(JOA)评分为(10.9±4.2)分,末次随访时JOA评分为(14.8±2.8)分。     

The transoral approach to the cervical spine.

The transoral surgical approach is useful for operating on structures at the base of the brain and the upper cervical spinal cord. For example, this route has been used for resecting spinal tumors and clipping vertebrobasilar aneurysms. In the past, this surgical approach was not advocated due to concerns about exposure and infection. However, the availability of the microscope, computed tomography, computed myelotomography, magnetic resonance imaging and intraoperative radiography as well as more effective techniques have improved the diagnosis of pathology of the craniovertebral junction and surgical performance. An understanding of the operative procedures involved with this approach assists the neuro-science nurse in preoperative teaching and anticipating potential postoperative complications.