Chiari畸形合并脊髓空洞患者后颅窝减压术后脊柱侧凸的自然转归分析  

Natural history of scoliosis after posterior fossa decompression in patients with Chiari malformation/syringomyelia -

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

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中华医学杂志》2014年第1期22-26,共5页National Medical Journal of China

基　　金：国家自然科学基金（81171672）

摘　　要：目的评估Chiari畸形／脊髓空洞患者后颅窝减压术（PFD）后脊柱侧凸的自然进展并分析影响侧凸转归的相关因素。方法对2002年1月至2007年12月期间南京大学医学院附属鼓楼医院脊柱外科PFD治疗的26例Chiari畸形／脊髓空洞伴脊柱侧凸患者的影像学资料进行回顾性分析，记录PFD术前及末次随访时主弯Cobb角、弯型、矢状面参数（胸椎后凸、胸腰段交界后凸、腰椎前凸）、小脑扁桃体下疝程度、空洞大小及长度。定义末次随访Cobb角小于或等于行后颅窝减压术时5。为侧凸未进展（未进展组），大于行后颅窝减压术时5。以上为侧凸进展（进展组）。运用成组设计资料t检验和Fisher精确检验比较两组PFD术前各项参数间的差异。结果26例患者接受PFD手术时平均年龄6．5～14．7（10．3±2．4）岁，主弯Cobb角20—45（33．5±7．7）°。术后24—118（57．5±26．9）个月随访时，11例（42％）患者脊柱侧凸获得稳定或改善。进展组平均初始年龄显著大于非进展组（11．1±2．2）比（9．2±2．2）岁，P=0．041，此外进展组中胸腰双弯比例显著高于非进展组（26．7％比9．1％，P=0．037）。而Cobb角、Risser征、矢状面参数、小脑扁桃体下疝程度、空洞大小及长度、术前伴神经症状／体征比例在两组间差异均无统计学意义（均P〉0．05）。结论后颅窝减压术后42％的Chiari畸形／脊髓空洞患者可获得脊柱侧凸的稳定或改善。PFD手术时年龄较大、胸腰双弯弯型可能是术后脊柱侧凸进展的危险因素。Objective To explore the natural history of scoliosis after posterior fossa decompression （PFD） in patients with Chiari malformation/syringomyelia and examine the risk factors associated with curve progression. Methods A retrospective radiographic study was performed at our scoliosis center for 26 patients undergoing PFD for Chiari malformation between January 2002 and December 2007. Their clinical and radiological parameters, including age, curve magnitude, curve pattern, extent of eerebelar tonsil herniation, maximal syrinx/cord ratio, syrinx size and length, were evaluated pre- and postoperatively. Curve progression was defined as an increment of Cobb angle over 5° compared with that of initial curve （progression group）; whereas an increment of Cobb angle equal to or under 5° was considered curve stabilization or improvement （ non-progression group）. All aforementioned parameters at the time of PFD were compared between two groups with Student t and Fisher exact tests. Results Their average initial age, curve magnitude and follow-up duration were 10. 3 ± 2.4 （ 6. 5 ± 14. 7 ） years, 33.5°± 7.7° （ 20° - 45° ） and 57.5 ± 26. 9 （24 - 118） months respectively. At the final follow-up, curve improvement or stabilization occurred in 11 （42%） patients. Compared with the non-progression group, significantly greater initial age was observed in the progression group （ 11.1± 2. 2 vs 9. 2 ±2. 2 years, P = 0. 041 ）. In addition, the percentage of double major curve was significantly higher in the progression group than that in the non- progression group （26. 7% vs 9. 1%, P = 0. 037）. With regards to Cobb angle, Risser sign, extent of cerebelar tonsil herniation, maximal syrinx/cord ratio, syrinx length, sagittal parameters and percentage of patients with preoperative neurological signs or symptoms, no significant differences existed between two groups （P 〉 0. 05 ） . Conclusion PFD may halt curve progression in 42% of patients with Chiari malformation/syringomyelia. And th

关 键 词：脊髓空洞症 脊柱侧凸 减压术 外科 CHIARI畸形 

分 类 号：R687.3[医药卫生—骨科学]