枕大池成形术对Chiari畸形Ⅰ型伴脊髓空洞症患者疗效及脑脊液动力学的影响  

Effect of cisterna magna plastic repairing on cerebrospinal fluid dynamics in Chiari malformation type I with syringomyelia

作　　者：包长顺[1] 陈明生[1] 杨福兵[1] 张苓[1] 刘亮[1] 王斌[1] 陈礼刚 

机构地区：[1]泸州医学院附属医院神经外科,泸州646000

出　　处：《中华神经医学杂志》2015年第7期735-739,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨枕大池成形术（后颅窝减压＋小脑扁桃体部分切除＋硬膜成形）对Chiari畸形Ⅰ型伴脊髓空洞症（CMI-SM）患者疗效及脑脊液动力学的影响。方法泸州医学院附属医院神经外科自2011年1月至2013年12月应用枕大池成形手术治疗CMI-SM患者40例，术前24h及术后12个月患者均行核磁共振相位对比序列（PC-MRI）检查及日本矫形科学学会（JOA）脊髓功能评分，比较患者中脑导水管、脑桥腹侧、C3腹侧层面脑脊液动力学指标及JOA评分的变化。结果术后没有患者出现神经功能恶化或死亡，JOA评分从（7．89±3．52）分提高到（12．53±4．32）分，差异有统计学意义（P〈0．05）；PC-MRI扫描显示患者术后枕大池成形良好，脊髓蛛网膜下腔通畅，30例患者脊髓空洞明显缩小；与术前24h比较，患者术后12个月脑脊液每搏输出量（SV）、平均流量（MF）均增加、头端和尾端最大峰值流速（Vmax）均降低，差异有统计学意义（P〈0．05）。结论枕大池成形术可以增加病变区脑脊液流量，减缓脑脊液峰值流速，从而缓解临床症状、减轻脊髓空洞，是一种有效的手术方式．Objective To explore the effect of cistema magna plastic repairing （posterior vertebral column resection and cerebella tonsillectomy and reconstruction of the cistema magna by artificial dura） on cerebrospinal fluid dynamics in Chiari malformation type I with syringomyelia and evaluate the efficacy of this surgical method. Methods Forty patients with Chiari malformation type I with syringomyelia （CMI-SM）, admitted to and diagnosed by MRI in our hospital from January 2011 to December 2013, were selected. All patients were treated with cistema magna plastic repairing. Phase-contrast MR imaging （PC-MRI） was performed, changes of cerebrospinal fluid dynamics indicators of cerebral aqueduct, pons ventral side and C3 ventral side were detected and compared and Japanese Orthopaedic Association （JOA） scale scores were evaluated 24 h before operation and 12 months after operation. Results No neurological deterioration or death was noted; JOA scores in all patients were increased from 7.89±3.52 to 12.53±4.32, with significant difference （P〈0.05）; post-operated PC-MRI indicated that the cistema magna formed well, spinal subarachnoid space was clear, syringomyelia in 30 patients was significantly reduced; as compared with those before operation, the stroke volume and mean flux were significantly increased, but maximum peak velocity was significantly reduced （P〈0.05）. Conclusion Cistema magna plastic repairing can reduce syringomyelia, increase cerebrospinal fluid flow, and reduce peak flow of cerebrospinal fluid, which is an effective surgical procedure for Chiari malformation type I with syringomyelia.

关 键 词：枕大池成形术 CHIARI畸形 脊髓空洞症 脑脊液动力学 

分 类 号：R651.1[医药卫生—外科学]