硬膜外层剥离联合人工硬膜贴敷治疗成人Arnold-Chiari畸形Ⅰ型合并脊髓空洞的初步探讨  

Epidural layer stripping combined with artificial dural application in treatment of Arnold-Chiari malformation type Ⅰ with syringomyelia

作　　者：李新军[1] 韩杨云[1] 龙晓东[1] 孙中书[1] 叶锋[1] 陈晨[1] 刘盈盈[2] LI Xin-Jun;HAN Yang-Yun;LONG Xiao-Dong;SUN Zhong-Shu;YE Feng;CHEN Chen;LIU Ying-Ying(Department of Neurosurgery,People’s Hospital of Deyang City,Deyang,Sichuan 618000,China;Department of Neurology,People’s Hospital of Deyang City,Deyang,Sichuan 618000,China)

机构地区：[1]四川省德阳市人民医院神经外科,四川德阳618000 [2]四川省德阳市人民医院神经内科,四川德阳618000

出　　处：《国际神经病学神经外科学杂志》2021年第2期163-166,共4页Journal of International Neurology and Neurosurgery

摘　　要：目的探讨硬膜外层剥离技术联合人工硬膜贴敷在Arnold-Chiari畸形Ⅰ型合并脊髓空洞的治疗效果。方法分析86例Arnold-Chiari畸形Ⅰ型合并脊髓空洞患者的临床资料,根据硬膜处理方式,分为观察组(硬膜外层剥离联合人工硬膜贴敷32例)、对照1组(硬膜外层间断划开减张21例)、对照2组(硬膜扩大成形33例),对比观察组与对照组在术中超声、手术时间、脊髓空洞变化、神经功能改善、术区感染、术区积液、脑脊液漏、住院时间等指标的差异。结果三组患者均无新发神经功能缺损症状,无术后瘫痪、呼吸功能衰竭、死亡病例发生。三组间术后脊髓背侧脑脊液流速峰值、电生理监测、脊髓空洞缩小、住院时间、术区感染、术区积液及脑脊液漏比较,差异有统计学意义(P<0.05);三组间神经功能改善方面、手术时间比较,差异无统计学意义(P>0.05)。在术后脊髓背侧脑脊液流速峰值、脊髓空洞缩小比较中:观察组与对照1组差异有统计学意义(P<0.05),与对照2组差异无统计学意义(P>0.05);在电生理监测、住院时间、术区感染、术区积液、脑脊液漏比较中:观察组与对照1组差异无统计学意义(P>0.05),与对照2组差异有统计学意义(P<0.05)。结论应用硬膜外层剥离联合人工硬膜贴敷治疗Arnold-Chiari畸形Ⅰ型合并脊髓空洞,较传统处理方式可靠、安全、有效。Objective To explore the therapeutic effect of epidural layer stripping combined with artificial dural application in the treatment of Arnold-Chiari malformation type Ⅰ with syringomyelia.Methods An analysis was performed on the clinical data of 86 cases of Arnold-Chiari malformation type Ⅰ with syringomyelia;based on the treatment of the dura matter,the patients were divided into observation group(epidural layer stripping and artificial dural application,32 cases),control group 1(intermittent incision of the epidural layer for decompression,21 cases),and control group 2(expansive duraplasty,33 cases).The observation group and control groups were compared for differences in indices such as intraoperative ultrasound findings,operation duration,changes in spinal cavities,neurological function improvement,operation site infection,operation site effusion,cerebrospinal fluid(CSF) leak,and length of hospital stay.Results No patients in the three groups had any symptoms of new neurological deficit,postoperative paralysis,respiratory failure,or fatal outcomes.There were significant differences between the three groups in postoperative peak velocity of dorsal CSF,electrophysiological monitoring results,spinal cavity shrinkage,length of hospital stay,operation site infection,operation site effusion,and CSF leak(P <0.05),but there were no significant differences between the three groups in neurological function improvement or operation duration(P>0.05).In terms of postoperative peak velocity of dorsal CSF and spinal cavity shrinkage,there were significant differences between the observation group and the control group 1(P <0.05) but not between the observation group and the control group 2(P>0.05).In terms of electrophysiological monitoring results,length of hospital stay,operation site infection,operation site effusion,and CSF leak,there were significant differences between the observation group and the control group 2(P <0.05) but not between the observation group and the control group 1(P>0.05).Conclusions It is safe

关 键 词：硬膜外层剥离 人工硬膜贴敷 Aronld-Chiari畸形Ⅰ型 脊髓空洞症 神经外科手术 

分 类 号：R651.11[医药卫生—外科学]