| ObjectiveTo evaluate the clinical efficacy of Klippel-feil syndrome(KFS)consider up cervical instability by diagnosis and management of KFS patients before and after operation.MethodsIn this study,we retrospectively studied 8 patients with KFS with up cervical instability from April 2008 to June 2015.Among them,there are 3 males and 5 females whose age 25-45 years old,average 38.5 years old.8 patients were congenital fusion of C2-3,in which the fusion site 3 cases of C2 and C3 vertebral body,lamina and spinous process fusion,the rest of the C2,C3 lamina and spinous process fusion;subjects with atlantoaxial dislocation were 8 cases;congenital free dentate process was 1 case,congenital occipitalization of the atlas were 7 cases;skull base depression were 7 cases;accompanied by spinal cord compression were 8 cases;spinal cord signal abnormalities were 3 cases;accompanied by neurological symptoms were 8 cases;incomplete paralysis were 7 cases;only one case had operation history.All 8 patients underwent cervical JOA score(Japanese Orthopedic Association assessed treatment scores)and ASIA score(American Spinal Cord Injury Association assessed spinal cord injury score).The patients were treated with physical examination,cervical X-ray,CT and MRI.Four of them underwent transoral anterior releasing and bone graft and reconstruction by atlantoaxial fusion plate.Three cases underwent transoral anterior releasing and posterior occipital-cervical fusion.The last one case was reset by traction,underwent bone graft and posterior occipital-cervical fusion through 3D navigation template.Patients were given rational management according to different condition after the operation,given postoperative rehabilitation training and health education,regular review of X,CT,MRI and other tests,and to give cervical JOA score,ASIA score and physical examination.Results8 patients were based on their signs and clinical symptoms,combined with imaging examination to select the appropriate surgical treatment,patients with better compliance,were followed up to so far,8 patients review X-ray,No fixation within the fixed,have access to good bone graft fusion.8 cases of patients without spinal cord,nerve root and vertebral artery injury;1 patient emerged incision infection after surgery.The active anti-infection and debridement and other measures were adopted to control this complication.After five months this patient emerged limb muscle force reduction,X-ray review indicated atlantoaxial dislocation recurrence,the second hospitalization turned to posterior occipital-cervical fusion.This patient turn up cerebrospinal fluid leakage and drink cough after the second postoperative.Eight patients had no incontinence.The JOA score of the cervical spine was 9 ± 2.93,15 ± 2.62,p <0.05,and the data of the two groups were statistically different.The preoperative ASIA sensory score was 210.38 ± 1,10.36,the last postoperative 219.88 ± 2.03,p <0.05,the two groups of data were statistically significant;preoperative ASIA exercise score was 77.25 ± 8.35,the last postoperative 91.75 ± 6.88,p <0.05,the two groups of statistics according to the statistical results,it can be proved that the curative effect of KFS patients with unstable cervical spine surgery is different,and there is a significant improvement after operation.ConclusionAccompanied by up cervical instability in patients with KFS surgical treatment is still at risk,and the use of 3D navigation template significantly reduces the risk of surgery.In contrast,the postoperative symptoms were relieved or were cured.Patients put up higher surgical satisfaction,so the surgical treatment with cervical instability KFS is a very high feasible treatment.Even so,the experimental sample data is small,lack of large sample data support,the study needs to be further improved. |
PDF Full Text Request