Chiari畸形后颅窝减压术后延髓及小脑位置变化与空洞转归的相关性  

Correlation between the shifting of medulla oblongata and cerebellum and syrinx resolution after posterior fossa decompression in Chiari malformation

作　　者：谢丁丁[1] 朱泽章[1] 邱勇[1] 沙士甫[1] 江龙[1] 钱邦平[1] 孙旭[1] 闫煌[1] 

机构地区：[1]南京大学医学院附属鼓楼脊柱外科,210008

出　　处：《中华外科杂志》2013年第10期895-899,共5页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目面上项目（81171672）;江苏省医学重点人才资助项目（RC2011148）

摘　　要：目的 测量青少年Chiari畸形伴脊髓空洞患者后颅窝减压（PFD）手术前后延髓及小脑的位置,并分析其变化趋势与空洞转归之间的相关性.方法 回顾性分析2006年9月至2011年9月接受治疗并符合入选标准的46例青少年Chiari畸形伴脊髓空洞患者的资料,其中男性25例,女性21例；年龄10～17岁,平均（13.9±1.9）岁.患者随访时间6～52个月,平均（13±12）个月.在正中矢状位MRI上测量术前及末次随访时的延髓脑桥沟、第四脑室顶点、小脑扁桃体下端的纵向及横向位置、延髓脊髓角、空洞的最大前后径与同水平处脊髓前后径的比值（S/C最大比值）及空洞的长度.采用配对样本t检验分析PFD前后上述指标间的差异,使用双变量相关性分析具有统计学差异的指标的变化值与空洞改善之间的相关性.结果 PFD术后31例（67.4％）患者延髓脑桥沟向上方移位,35例（76.0％）患者小脑扁桃体下端向上方移位.40例（86.9％）患者脊髓空洞改善,S/C最大比值、脊髓空洞长度在PFD手术前后的差异具有统计学意义（t=7.114和7.816,P=0.000）,S/C最大比值及空洞长度的改善率分别为32％±30％和43％±33％.延髓脑桥沟的上移（r =0.332,P=0.027）、小脑扁桃体下端的上移（r=0.298,P=0.044）与S/C最大比值改善率之间具有显著相关性.结论 青少年Chiari畸形伴脊髓空洞患者PFD术后延髓脑桥沟及小脑扁桃体下端的上移对脊髓空洞的改善有促进作用.Objectives To evaluate the changes of the position of medulla oblongata and cerebellum following posterior fossa decompression （PFD）,and to investigate their influences on the prognosis of the syringomyelia in adolescents with Chiari malformation （CM）.Methods A retrospective review was performed on all CM patients between September 2006 and September 2011.A subset of 46 patients,including 25 male and 21 female patients,was finally enrolled according to the inclusion criteria.The initial age and duration of follow-up averaged 13.9 years （range,10-17 years） and 13 months （range,6-52 months）,respectively.On mid-sagittal MRI,the following parameters were evaluated pre-and postoperatively （follow-up≥6 months）：the longitudinal and transverse position of bulbopontine sulcus,the fourth ventricle vertex,the lower extreme of cerebella tonsil,the cervico-medullary angle,the maximal syrinx/cord（S/C） ratio and the syrinx length.Changes in these parameters were analysed using the paired samples t test,and for these reaching statistical significances,an additional bivariate correlation analysis was performed to investigate their relation with syrinx resolution.Results At the latest follow-up,upward shifting of the bulbopontine sulcus was observed in 31 patients （67.4%）,with upward shifting of the lower extreme of cerebella tonsil presenting in 35 patients（76.0%）.The maximal S/C ratio and the syrinx length were significantly improved postoperatively （t =7.114 and 7.816,P =0.000）.Significant resolution of the syrinx was demonstrated in 40 patients（86.9%）,and more specifically,the average improvement rates of the maximal S/C ratio and the syrinx length were 32% ± 30% and 43% ± 33%,respectively.In addition,the bivariate correlation analysis revealed that syrinx resolution was significantly correlated with the upward shifting of the bulbopontine sulcus （r =0.332,P =0.027） and lower extreme of cerebella （r =0.298,P =0.044）.Conclusion The upward shifting of the bulbopontine sulcus

关 键 词：Arnold—Chiari畸形 脊髓空洞症 小脑 青少年 

分 类 号：R743[医药卫生—神经病学与精神病学]