不同范围骨性减压治疗Chiari畸形Ⅰ型的临床疗效比较  

Comparison of the clinical effectiveness of different ranges of bony decompression for the treatment of Chiari malformation typeⅠ

作　　者：孟超 常飘飘 李中林 MENG Chao;CHANG Piaopiao;LI Zhonglin(Department of Neurology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China;School of Nursing Care,Jiuzhou Vocational and Technical College,Xuzhou,Jiangsu 221116)

机构地区：[1]徐州医科大学附属医院神经外科,江苏徐州221002 [2]九州职业技术学院护理学院,江苏徐州221116

出　　处：《徐州医科大学学报》2023年第7期480-484,共5页Journal of Xuzhou Medical University

摘　　要：目的比较不同范围骨性减压治疗Chiari畸形Ⅰ型的临床疗效。方法回顾性分析2016年1月—2022年7月于徐州医科大学附属医院接受手术治疗的162例Chiari畸形Ⅰ型患者的临床资料,根据手术类型分为保留组(n=99)与切除组(n=63)。2组患者接受后颅窝骨性减压+下疝小脑扁桃体切除+硬脑膜扩大成型术,其中切除组在后颅窝骨性减压中将寰椎后弓咬除,保留组保留寰椎后弓。比较2组患者手术时间、术中出血量、芝加哥Chiari预后量表(CCOS)评分和术后6个月脊髓空洞的缓解情况。比较2组患者住院时间和术后并发症发生情况。结果2组患者术中出血量、住院时间、CCOS预后评分、脊髓空洞缓解情况等比较差异无统计学意义(P>0.05)。切除组患者手术时间显著长于保留组〔(207.17±55.87)min vs(188.36±56.37)min〕,差异有统计学意义(P<0.05)。切除组患者术后发热、颅内感染、切口愈合不良发生率高于保留组,差异有统计学意义(P<0.05)。结论2种手术类型均能够有效改善患者脊髓空洞症和远期CCOS预后评分,且疗效无明显差异。术中保留寰椎后弓节省了手术时间,降低了患者术后发热、颅内感染、切口愈合不良等并发症的发生率。Objective To compare the clinical effectiveness of different ranges of bony decompression for the treatment of Chiari malformation typeⅠ.Methods A total of 162 patients with Chiari malformation typeⅠwho underwent surgical treatment in the Affiliated Hospital of Xuzhou Medical University from January 2016 to July 2022 were enrolled and their clinical data were retrospectively analyzed.According to surgical types,they were divided into two groups:a preservation group(n=99)and a resection group(n=63).Patients in both groups underwent posterior fossa decompression+tonsillectomy+duraplasty,where the posterior arch of atlas was removed in the resection group but retained in the preservation group.Both groups were compared for the duration of surgery,perioperative blood loss,urthermore,the Chicago Chiari Outcome Scale(CCOS)scores and resolution of syringomyelia at postoperative six months were compared.Furthermore,the length of hospitalization stay and postoperative complications were recorede and compared.Results There was no statistical difference in perioperative blood loss,the length of hospitalization stay and CCOS scores and the recovery of syringomyelia between the two groups(P>0.05).However,the duration of surgery was significantly longer in the resection group than that in the preservation group〔(207.17±55.87)min vs(188.36±56.37)min〕(P<0.05).The incidences of postoperative fever,intracranial infection and poor incision healing were significantly higher in the resection group than those in the preservation group(P<0.05).Conclusions Both types of the surgery are effective in improving syringomyelia and long-term CCOS scores,without significant difference in effectiveness.Intraoperative preservation of the posterior arch of atlas can save operative time and reduce the incidences of complications such as postoperative fever,intracranial infection and poor incisional healing.

关 键 词：Chiari畸形Ⅰ型 寰椎后弓 脊髓空洞 预后 并发症 

分 类 号：R651.1[医药卫生—外科学]