Chiari畸形合并脊髓空洞症手术方式的探讨  

Surgical treatment of Chiari malformation accompanied by syringomyelia

作　　者：许忠[1] 陈焕燃[2] 乔振才[1] 杨凤笙[1] 徐文俊[1] 王荣[1] 许民辉[2] 

机构地区：[1]武警江苏总队医院神经外科,扬州225003 [2]第三军医大学大坪医院野战外科研究所神经外科,重庆400042

出　　处：《武警医学》2005年第7期510-513,共4页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的探讨Chiari畸形合并脊髓空洞症(CM-SM)的手术方式。方法回顾分析实施手术治疗34例CM-SM的磁共振(MRI)影像学资料。单纯颅后窝减压术(PFD)7例,PFD+硬脑膜成形术(PFDD)27例。23例得到MRI随访。通过对颅颈交界区(CCJ)蛛网膜下腔(SS)形态学异常在Chiari畸形合并脊髓空洞症发病机理中意义的研究,根据随访的临床症状体征和影像学改变情况,测量小脑扁桃体下疝程度(ECT)、颅后窝(PCF)和CCJ和其内SS的容积形态学指标以及各手术组的有效率,与术后、有效率对照,分析CM-SM发病机制和疗效。结果术后小脑扁桃体平均上抬10.07mm,PCF和CCJ容积分别平均增加11.29ml和6.29ml,整个CCJ区SS容积均较术前平均增加14.44ml(2.2倍),与术前的相比差异均显著(P<0.01);PFD有效率71.4%,PFDD有效率96.3%,两者相差显著(P<0.05)。结论颅后窝减压+硬脑膜成形术是治疗CM-SM的一种较有效的手术方式。Objective To study the operative technique of treating Chiari malformation accompanied by syringomyelia(CM-SM).Methods The magnetic resonance images (MRI) in 34 CM-SM patients were reviewed. Twenty-seven patients underwent posterior fossa decompression with duraplasty (PFDD),while the other 7 patients without duraplasty (PFD);of them 23 were followed up with MRI. The extent of cerebellar tonsillar hernia (ECT), the volumes of the posterior cranial fossa(PCF),cranio-cervical junction (CCJ),subarachnoid space (SS) on the sagital MRI,and the effective ratio after procedure were measured, based on alteration of local subarachnoid space in pathogenesis of Chiari malformation accompanied by syringomyelia.Results Cerebellar tonsils elevated 10.07 mm,the PCF and CCJ volume increased by 11.29 ml and 6.29ml,respectively,after the procedure. The SS volume in CCJ region increased 14.44 ml (2.2 times that before the procedure). These changes were of statistically significant difference,compared with pre-procedure (P<0.01).The effective ratio of PFDD (mean,96.3%) was significant higher than that of PFD (mean, 71.4%)(P<0.05).Conclusions PFDD for the treatment of CM-SM is preferable.

关 键 词：Chiari畸 脊髓空洞症 手术方式 形合 硬脑膜成形术 小脑扁桃体下疝 颅后窝减压术 影像学资料 形态学异常 蛛网膜下腔 颅颈交界区 影像学改变 形态学指标 有效率 手术治疗 回顾分析 症状体征 发病机制 磁共振 SM CM MRI 

分 类 号：R651.2[医药卫生—外科学] R744.4[医药卫生—临床医学]