小脑扁桃体下疝减压术中肌硬膜桥的处理对术后效果及并发症的影响  

Effect of myodural bridge management on postoperative results and complications during decompression of subcerebellar tonsillar herniation

作　　者：王杰[1] 费明杨 李俊[1] 于胜波 隋鸿锦 董斌[1] WANG Jie;FEI Ming-yang;LI Jun(Department of Neurosurgery,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连医科大学附属第一医院神经外科,大连116011 [2]大连医科大学基础医学院解剖学教研室

出　　处：《临床神经外科杂志》2023年第2期179-182,共4页Journal of Clinical Neurosurgery

基　　金：辽宁省自然科学基金项目(2014023021)。

摘　　要：目的 探讨Chiari畸形I型(CMI)行小骨窗减压、寰枕筋膜松解术中对肌硬膜桥的处理方法,分析术中肌硬膜桥保护与术后相关并发症的关系。方法 回顾性分析大连医科大学附属第一医院神经外科2012年3月—2020年12月收治的38例Chiari畸形I型患者的临床资料,所有患者均行手术治疗,根据手术方式分为A、B两组;比较两组患者手术前后KPS评分及Tator评分,对比两组患者术后头痛发生率、颅内感染率及术后脑脊液漏情况。结果 在近期疗效方面,B组患者的总体好转略高于A组,但无统计学差异(A组好转率80.77%,B组好转率83.33%,P>0.05)。结论 后颅窝小骨窗减压+寰枕筋膜头侧2/3松解术能够保护肌硬膜桥的解剖结构,治疗小脑扁桃体下疝I型效果显著,且术后患者头痛、颅内感染和脑脊液漏并发症率低,提示肌硬膜桥的保护和功能重建可能发挥重要作用。Objective To investigate the management of myodural bridge during small bone window decompression and atlanto-occipital fasciolysis of Chiari type I malformation(CMI),and to analyze the relationship between intraoperative myodural bridge protection and postoperative complications.Methods The clinical data of 38 patients with type I Chiari malformation admitted to the Department of Neurosurgery,the First Affiliated Hospital of Dalian Medical University from March 2012 to December 2020 were analyzed retrospectively.All patients received surgical treatment and were divided into two groups according to the surgical methods.The KPS score and Tator score before and after surgery were compared between the two groups,and the incidence of postoperative headache,intracranial infection rate and postoperative cerebrospinal fluid leakage were compared between the two groups.Results In terms of short-term efficacy,the overall improvement of group B was slightly higher than that of group A,but there was no statistical difference(80.77%improvement rate of group A,83.33%improvement rate of group B,P>0.05).Conclusions Small bone-fenestrae decompression of posterior fossa and cephalic 2/3 release of atlanto-occipital fasciolysis can protect the anatomical structure of the myodural bridge,and has a significant effect on the treatment of subcerebellar tonsillar hernia type I,and the complication rate of postoperative headache,intracranial infection and cerebrospinal fluid leakage in patients is low,suggesting that the protection and functional reconstruction of the myodural bridge may play an important role.

关 键 词：小脑扁桃体下疝 肌硬膜桥 后颅窝减压术 疗效比较研究 

分 类 号：R651[医药卫生—外科学]