不同减压术式治疗Chiari Ⅰ型畸形合并脊髓空洞症疗效比较  

Efficacy comparison of different decompressions treatment on Chiari Ⅰ deformity associated with syringomyelia

作　　者：李强[1] 李逢佳[1] 姜宗飞[1] LI Qiang;LI Fengjia;JIANG Zongfei(Department of Neurosurgery,Laiwu city People’s Hospital,Laiwu 271199,China)

机构地区：[1]山东省莱芜市人民医院神经外科,山东莱芜271199

出　　处：《现代仪器与医疗》2018年第1期1-3,共3页Modern Instruments & Medical Treatment

摘　　要：目的:比较不同减压术式治疗Chiari Ⅰ型畸形合并脊髓空洞症的疗效与安全性,为临床治疗方案的选择提供参考依据。方法:以我科2013年3月至2015年3月行减压术的124例Chiari Ⅰ型畸形合并脊髓空洞症患者为研究对象,进行回顾性分析。按照患者减压术式,将接受后颅窝小骨窗减压+下疝小脑扁桃体处理+第四脑室下端松解术治疗的41例患者纳入A组,将接受后颅窝常规减压+小脑扁桃体下疝复位+脊髓空洞蛛网膜下腔分流治疗的44例患者纳入B组,将常规大骨窗后颅窝减压+小脑扁桃体下疝复位治疗的39例患者纳入C组。比较3组患者近远期疗效、并发症发生情况,并应用日本骨科协会(JOA)评分系统及影像学参数评价其脊髓功能、脊髓空洞恢复情况。结果:3组患者出院时临床总有效率比较,差异无统计学意义(P>0.05),出院1年后A组患者临床总有效率高于B组、C组,差异有统计学意义(P<0.05)。A组并发症发生率均低于B组、C组,差异有统计学意义(P<0.05)。与术前相比,3组患者出院时、出院1年后JOA评分均升高、脊髓空洞大小均降低,A组变化更为明显,差异有统计学意义(P<0.05)。结论:三种减压术式治疗Chiari Ⅰ型畸形合并脊髓空洞症均可取得一定的效果,其中后颅窝小骨窗减压+下疝小脑扁桃体处理+第四脑室下端松解术治疗具有更为确切的临床疗效与更为可靠的安全性,值得推荐。Objective:The objective of this study was to compare the efficacy of different decompressions treatment on ChiariⅠdeformity associated with syringomyelia and their security,and to provide the basis for the clinical treatment.Methods:a total of 124 cases of patients with ChiariⅠdeformity associated with syringomyelia were selected as the study object,and their clinical data were retrospectively analyzed.Group A was comprised of 41 patients who were given decompression of posterior cranial fossa plus the cerebellar tonsillar treatment plus fourth ventricle lysis.Group B included 44 patients who were provided with posterior cranial fossa routine decompression plus Herniation of the lower brain tonsil plus spinal cavity-subarachnoid drainage.Group C composed of 39 patients who were treated with posterior cranial fossa decompression plus Herniation of the lower brain tonsil.The immediate and long-term outcomes,complications,spinal function and spinal cavity recovery assessed by Japanese Orthopedic Association(JOA)and image parameters of these three groups were compared.Results:The differences of the total effective rate of these three groups when discharging from hospital were not statistically significant(P>0.05).One year after discharge,the clinical effective rate of Group A was higher than that of Group B and C,the difference was statistically significant(P<0.05).Compared with the preoperative,the JOA of three groups when discharging and one year after discharging were increased,and the size of spinal cavity got smaller,and Group A was the most significant,the differences were statistically significant(P<0.05).Conclusion:These three methods can achieve certain effect on ChiariⅠdeformity associated with syringomyelia,among which decompression of posterior cranial fossa plus the cerebellar tonsillar treatment plus fourth ventricle lysis has better effect and is worthy of promotion.

关 键 词：后颅窝减压 ChiariⅠ型畸形 脊髓空洞症 疗效 

分 类 号：R744[医药卫生—神经病学与精神病学]