颅后窝减压+硬脑膜劈裂术与颅后窝减压+硬脑膜成形术治疗Chiari畸形Ⅰ型的疗效对比分析  

Clinical efficacy of surgery for patients with Chiari malformation typeⅠ:posterior fossa decompression with duraplasty versus posterior fossa decompression with dural splitting

作　　者：彭程 赵明光 PENG Cheng;ZHAO Ming-guang(Department of Neurosurgery,General Hospital of Northern Theater Command,Shenyang 110016,China;Department of Neurosurgery,The Air Force Hospital of Northern Theater Command,Shenyang 110092,China)

机构地区：[1]北部战区总医院神经外科,沈阳110016 [2]北部战区空军医院神经外科,沈阳110092

出　　处：《中国临床神经外科杂志》2023年第7期417-420,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的对比分析颅后窝减压+硬脑膜劈裂术(PFDDS)与颅后窝减压+硬脑膜成形术(PFDD)治疗Chiari畸形Ⅰ型(CM-Ⅰ)的临床疗效。方法回顾性分析2017年10月~2023年10月手术治疗的197例CM-Ⅰ的临床资料。113例采用PFDD治疗,84例采用PFDDS治疗。术后6个月依据芝加哥Chiari畸形预后量表(CCOS)评分评估疗效,其中13~16分为预后良好;根据MRI复查结果评估脊髓空洞改善情况。结果术后6个月,PFDDS组和PFDD组预后良好率分别为57.1%、54.9%,脊髓空洞改善率分别为78.5%、72.4%;两组预后良好率和脊髓空洞改善率均无统计学差异(P>0.05)。与PFDD组相比,PFDDS组手术时间和术中出血量明显减少(P<0.05)、术后住院时间明显缩短(P<0.05)。两组术后并发症发生率无统计学差异(P>0.05)。结论PFDDS和PFDD治疗CM-Ⅰ的临床效果确切,但PFDDS可减少手术时间、术中出血量,缩短住院时间。Objective To compare the clinical efficacy of posterior fossa decompression with duraplasty(PFDD)and posterior fossa decompression with dural splitting(PFDD)for patients with Chiari malformation typeⅠ(CM-Ⅰ).Methods The clinical data of 197 patients with CM-Ⅰwho were treated with operation from October 2017 to October 2023 were retrospectively analyzed.One hundren and thirteen patients were treated with PFDD,and 84 patients were treated with PFDDS.The efficacy was evaluated by the Chicago Chiari outcome scale(CCOS)score at 6 months after the surgery,with a score of 13~16 as a good prognosis.The improvement of syringomyelia was evaluated according to the MRI at 6 months after the surgery.Results The good prognosis rates were 57.1%and 54.9%and the improvement rates of syringomyelia were 78.5%and 72.4%of PFDDS and PFDD groups,respectively.There were no significant differences in the rates of good prognosis and syringomyelia improvement between both groups(P>0.05).The operative time and the intraoperative blood loss in PFDDS group were significantly lower than those in PFDD group(P<0.05).The length of postoperative hospital stay in PFDDS group was significantly shorter than that in PFDD group(P<0.05).There were no significant difference in the incidence of postoperative complications between both groups(P>0.05).Conclusions PFDDS and PFDD are effective in the treatment of patients with CM-Ⅰ,but PFDDS can reduce operative time and intraoperative blood loss,and shorten the length of postoperative hospital stay.

关 键 词：Chiari畸形Ⅰ型 颅后窝减压术 硬脑膜劈裂术 硬脑膜成形术 疗效 

分 类 号：R742.8[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]