不同术式治疗Chiari Ⅰ型畸形的比较  

Surgical therapies in the management of Chiari Ⅰ malformation

作　　者：李兵[1] 鲁晓杰[1] 李江安[1] 庞明志[1] 徐嘉[1] 

机构地区：[1]南京医科大学附属无锡第二医院神经外科,无锡214002

出　　处：《中华神经外科杂志》2015年第3期250-253,共4页Chinese Journal of Neurosurgery

摘　　要：目的 总结ChiariⅠ型畸形的临床表现和手术经验,探讨不同手术方式在治疗ChiariⅠ型畸形中的作用.方法 回顾性分析1997年1月至2013年9月161例ChiariⅠ型畸形成人患者,合并脊髓空洞的97例.其中52例行单纯后颅窝减压,64例行硬膜成形术,45例行扁桃体探查处理.结果 术后随访6～36个月,后颅窝减压组,硬膜成形术组,扁桃体探查处理组在头痛的改善率分别为81.3％,79.6％,80.0％（P ＞0.05）;上肢感觉障碍的好转率分别为33.3％,65.4％,65.0％,硬脑膜成形术组和扁桃体探查处理组较单纯颅骨减压术组的差异有统计学意义（P值分别为0.036及0.04,均＜0.05）,但是两组之间差异无统计学意义（P＞0.05）.脊髓空洞缩小率分别为40.0％,66.7％,66.7％.相对于单纯后颅窝减压组,硬膜成形术组能改善肢体感觉障碍（P=0.036）和脊髓空洞缩小（P =0.042）;扁桃体探查处理组分别为（P=0.040,0.044）.这两组之间差异无统计学意义.各组均没有小脑扁桃体下垂并发症和死亡病例.结论 三种术式均能缓解头痛.在改善肢体感觉障碍和脊髓空洞缩小方面,硬膜成形术组,扁桃体探查处理组疗效较好.应根据患者的临床表现采用个体化的临床术式治疗Chiari Ⅰ畸形.Objective To evaluate and compare the efficacy among posterior fossa decompression,posterior fossa decompression combined with duraplasty and posterior fossa decompression with cerebellar tonsil exploration in the treatment of Chiari Ⅰ malformation （CM Ⅰ）.Methods We retrospectively studied 161 Chiari Ⅰ malformation patients treated between Janurary 1997 and September 2013.52 patients received pure decompression of posterior cranial fossa,64 patients underwent posterior fossa decompression with duraplasty,the rest with cerebellar tonsil exploration.Results No patients died in three groups after operation.The improvement rate of headache were 81.3%,79.6% and 80.0% （P 〉0.05）respectively in three groups.The extremity sensory disturbance was improved in 33.3%,65.4% and 65.0% patients respectively in three groups.The syringomyelia was decreased in 40.0%,66.7% and 66.7% patients respectively in three groups.Conclusions Posterior fossa decompression was a reasonable option for the treatment of headache pain in Chiari Ⅰ malformation.Posterior fossa decompression with duraplasty and posterior fossa decompression with cerebellar tonsil exploration were good choice in the treatment of extremity sensory disturbance and syringomyelia.

关 键 词：CHIARI畸形 脊髓空洞 后颅窝减压 

分 类 号：R651.1[医药卫生—外科学]