Chiari畸形Ⅰ型手术疗效的影响因素分析  

Analysis of influencing factors of surgical outcomes in Chiari malformation typeⅠ

作　　者：余跃 段磊[1] 李国强 袁帅[1] 袁治[1] 许彦龙 张祎年[1] Yu Yue;Duan Lei;Li Guoqiang;Yuan Shuai;Yuan Zhi;Xu Yanlong;Zhang Yinian(Department of Neurosurgery,Laboratory of Neurosurgery,the Second Hospital of Lanzhou University,Key Institute of Neurology of Gansu Province,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院神经外科,神经外科实验室,甘肃省神经病学重点实验室,兰州730030

出　　处：《中华神经外科杂志》2023年第1期61-67,共7页Chinese Journal of Neurosurgery

基　　金：甘肃省基础研究创新群体项目(21JR7RA432);甘肃省陇原青年创新创业人才项目(201712128)。

摘　　要：目的探讨影响Chiari畸形Ⅰ型(CM-Ⅰ)患者手术疗效的相关因素。方法回顾性分析2017年1月至2020年12月兰州大学第二医院神经外科收治的77例CM-Ⅰ患者的临床资料。采用后颅窝骨性减压+硬膜扩大成形术治疗25例,后入路固定术治疗52例。采用芝加哥Chiari畸形预后量表(CCOS)评分评估患者术后的短期疗效(出院时)、长期疗效(术后≥3个月)及疗效改善程度(即长期疗效较短期疗效提高的程度)。通过单因素分析和多元线性回归模型分析CM-Ⅰ手术疗效的影响因素。结果首发症状不同的患者出院CCOS评分存在差异(P=0.008)。术前不伴肢体无力、括约肌功能异常、小脑性共济失调、行走不稳,无脊柱侧弯,手术风险分级标准(NNIS)评分低的患者,出院CCOS评分更高,差异均有统计学意义(均P<0.05)。术前伴有枕部疼痛、无扁平颅底、美国麻醉医师协会(ASA)麻醉分级Ⅰ级的患者,术后≥3个月的CCOS评分更高,差异均有统计学意义(均P<0.05)。年龄为18~40岁,术前伴有肢体无力,合并寰枢椎脱位、寰枕融合,不合并扁平颅底,行后入路固定术的患者,CCOS评分改善更多,差异均具有统计学意义(均P<0.05)。术前肢体无力、脊柱侧弯均是CM-Ⅰ术后短期疗效的影响因素(均P<0.05)。ASA术前麻醉风险分级是CM-Ⅰ术后长期疗效的影响因素(P=0.047)。术前肢体无力、扁平颅底是CM-Ⅰ疗效改善程度的影响因素(均P<0.05)。结论术前不伴肢体无力、脊柱侧弯的CM-Ⅰ患者术后短期疗效更好,ASA术前麻醉风险分级低者术后长期疗效更好。术前伴肢体无力,无扁平颅底的CM-Ⅰ患者疗效改善程度更好。Objective To explore the related factors affecting the surgical outcome in patients with Chiari malformation typeⅠ(CM-Ⅰ).Methods The clinical data of 77 CM-Ⅰpatients admitted to the Department of Neurosurgery of the Second Hospital of Lanzhou University from January 2017 to December 2020 were retrospectively analyzed.Twenty-five cases were treated with posterior cranial fossa bony decompression and expanded dural angioplasty,and 52 cases were treated with posterior approach fixation.The Chicago Chiari outcome scale(CCOS)was used to evaluate the short-term efficacy(at discharge),long-term efficacy(≥3 months after surgery),and the improvement of curative effect(improvement of long-term efficacy over short-term efficacy).The influencing factors of CM-Ⅰoperation efficacy were analyzed by univariate analysis and multiple linear regression model.Results The CCOS scores at discharge varied in patients with different first symptom(P=0.008).Patients without limb weakness,abnormal sphincter function,cerebellar ataxia,unsteady walking or scoliosis before operation,and those with low national nosocomial infection surveillance risk index(NNIS)scores had higher CCOS scores at discharge,and the differences were statistically significant(all P<0.05).Patients with preoperative occipital pain,American Society of Anesthesiologists(ASA)anesthesia classⅠ,and those without platybasia had higher CCOS scores≥3 months after operation,and the differences were statistically significant(all P<0.05).Patients aged 18 to 40 years old,with preoperative limb weakness,combined with atlantoaxial dislocation,atlanto-occipital fusion,without platybasia and treated with posterior approach fixation had more improvement in terms of the CCOS score,and the differences were statistically significant(all P<0.05).Preoperative limb weakness and scoliosis were the influencing factors of short-term efficacy after CM-Ⅰsurgery(both P<0.05).ASA preoperative anesthesia risk classification was the influencing factor of long-term efficacy after CM-�

关 键 词：ARNOLD-CHIARI畸形 治疗结果 寰枕关节 影响因素分析 后颅窝减压术 

分 类 号：R651.1[医药卫生—外科学]