成年单纯Chiari畸形Ⅰ型患者后颅窝骨性结构的形态学研究  

Morphological study of bone structure of the posterior cranial fossa in adults with Chiari malformation typeⅠwithout basilar invagination

作　　者：王聖茜 胡晓珺 李洋 夏永智[1] 晏怡[1] WANG Shengxi;HU Xiaojun;LI Yang;XIA Yongzhi;YAN Yi(Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China)

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016

出　　处：《第三军医大学学报》2020年第22期2238-2243,共6页Journal of Third Military Medical University

基　　金：国家临床重点专科建设项目(财社[2011]170号)。

摘　　要：目的探讨无颅底凹陷的成人单纯Chiari畸形Ⅰ型(Chiari malformation typeⅠ,CMⅠ)患者后颅窝骨性结构的变化。方法收集2018年1月至2020年6月我科收治的成人单纯CMⅠ患者作为观察组,选取性别、年龄匹配的健康体检者作为对照组,根据头颈薄层CT数据比较两组受试者后颅窝骨性结构线性、角度及面积参数的差异。结果两组分别纳入38例,观察组斜坡长(P<0.001)、枕上长(P<0.01)、枕骨长(P<0.001)、Klaus高度指数(P<0.001)、后方压迫值(P<0.001)、小脑幕枕骨角(P<0.05)和后颅窝矢状面面积(P<0.001)均小于对照组,齿突压迫值(pBC2)(P<0.01)、齿突软组织压迫值(P<0.01)、前方压迫值(P<0.001)和基底角(P<0.01)均大于对照组,差异具有统计学意义。结论成人单纯CMⅠ斜坡及枕骨缩短并上抬,并伴有齿状突后缘骨质对延颈髓前方的压迫。Objective To examine the morphological characteristics of the bone structure in the posterior cranial fossa in adult patients with Chiari malformation typeⅠ(CMⅠ)without basilar invagination.Methods Thirty-eight adult patients with CMⅠwithout basilar invagination treated in our department between January,2018 and June,2020 were enrolled in this study as the observation group,and 38 gender-and age-matched healthy adults served as the control group.The differences in the linear and angular variables in the posterior cranial fossa were analyzed between the 2 groups based on thin-slice CT data.Results Compared with the control subjects,the patients with CMⅠshowed significantly decreased clivus length(P<0.001),supra-occipital length(P<0.01),occipital length(P<0.01),Klaus height index(P<0.001),posterior compressive value(P<0.01),tentorial angle(P<0.05)and sagittal area of the bony posterior cranial fossa(P<0.001)and significantly increased odontoid compressive value(P<0.01),odontoid and soft tissue compressive value(P<0.01),anterior compressive value(P<0.01)and basal angle(P<0.01).Conclusion In adult patients with CMⅠpatients but without basilar invagination,the clivus and occipital bone are shortened and elevated with co-existing ventral cervicomedullary compression by the posterior margin of the odontoid process.

关 键 词：CHIARI畸形 颅底凹陷 CT 后颅窝 

分 类 号：R321.6[医药卫生—人体解剖和组织胚胎学] R323.1[医药卫生—基础医学]