The Advantage And Disadvantage 0f The Treatment Of Pe Dicle Screw Placement Of Craniovertebral Junction Malfor Mation Whether Or Not Guided By Intraoperative Comput Ed Tomography With Integrated Neuronavigation Navigati On System (A Report Of 26 Cases)

Objective: By contrasting analysis of Craniovertebral Junction Malformationin patients with postoperative imaging data analysis and presence of complications and explore the advantages and disadvantages of posterior fixation surgery with pedicle screw fixation technology guided by intraoperative CT navigation.Methods: This 26 study patients with cranial neck border deformity are from neurosurgery department of general hospital of Shenyang military aera command from October 2011 to February 2015, male 8 cases, female with 18 cases. With pure base of skull concave 9 cases, 13 cases with cerebellar tonsillar hernia,atlanto-axial dislocation,4 cases of vertebral side piece, 7 cases with syringomyelia, ages from 24 to 68 years old with an average age of 46.5 years, course of 4 months ~ 60 years, average 5.6 years.Clinical manifestation: short neck deformity, neck deflection, 2 cases such as low success stories; Department head, neck and shoulder and upper extremity after progressive 18 cases,persistent pain, hoarseness, difficulty swallowing, drinking water choking cough(3 cases). 14 cases with its overlapping separation and progressiveinterosseous muscle atrophy symptoms such as feeling; 23 cases characterized by ataxia,nystagmus,Romberg sign positive. Patients were randomly divided into A, B two groups,adopt the dorsal decompression surgery, A group of 3 cases were male, female 10 cases,age 24 ~ 59 years old( 36.3 ±7.1 years), and group B(5 male, female 8 cases,aged 24 to 68(31.5±10.6 years), in which A group of fixed line unarmed experience,group B with intraoperative CT combined neural navigation under certain screw nail into point and fixed into the road. Group A hand according to the preoperative CT examination to determine the nail into the ordinary position and Angle cone drill into the nail into the road, for the cause, probe into group B fixed screw rod directly under CT navigation. Application of intraoperative CT scan further verify the pedicle screw position, satisfied after screw implant. According to the result of intraoperative CT navigation, group A will be detected by the screw rod wear TouGu cortex, compression of spinal cord, nerves, vertebral artery nail stick to readjust, row CT navigation satisfaction after fixed end again.Results: Preoperative and postoperative 3 months Nurick grading, 22 cases(84.6%)patients symptoms improved 1 level or above, 2 cases(7.7%) patients have no obvious improvement and 2 patients follow-up are failed. All patients are without artery and nerve function injury.The average operation time of Group A was 146 min, the bleeding an average of 194 ml, group B average operation time was 187 min, the bleeding an average of 214 ml, surgery does not appear in the process of serious complications and termination of the operation, all patients has not been intraoperative blood transfusion, all patients postoperative no vertebral artery or nerve complications occurred.5 patients in Group A apprear postoperative complications and 1 case of incision infection, 1 case of fat liquefaction of incision and 3 cases of pulmonary infection and 1 patients in Group B apprear pulmonary infection,, got cured after receiving antibiotic treatment,the 2 cases of incision healing after treatment,Postoperative outpatient care in 19 March, telephone follow-up in 5 cases, 2 cases were lost to follow-up. Postoperative 3 months there were no screw loose, outpatient care and nervous system symptoms, do not make processing. All the follow-up of patients withsymptoms.Conclusions: 1. The intraoperative CT can accurately evaluate the reset between atlas and axis and the trajectory of implanted screws, depth, and whether to wear out the cortex, thus effectively protect the cranial nerve vascular neck border area, at the same time avoid the risk of a second surgery patients; To improve the positioning, efficiently and improve the success rate of surgery path and is of great significance. But patients with intraoperative radiation exposure time is relatively long, and the operation cost is relatively high.2. Free-hand pedicle screw needs high technical requirements, solid professional knowledge and imaging position skills.Although patients with surgery,radiation exposure time is short, but through the risk of cortex intraoperative CT navigation is definitely too high.3.In terms of condition of each patient, we operative Pedicle Sc rew Placement according to the intraoperative CT guided navigation complete ind ividualized posterior fixation operation and corresponding fixation segment.4.Cranial neck border area stability reconstruction mainly nail intern al fixation by deformity of the system, although the risk of surgery is higher, bu t the reconstruction of cranial neck border stability is good.