改良后颅窝减压术对Ⅰ型Chiari畸形后颅窝形态学、颅颈交界区稳定性的影响  

Effect of Modified Posterior Cranial Fossa Decompression on the Morphology of the Posterior Cranial Fossa and Stability of the Craniocervical Junction Area in Chiari Malformation

作　　者：皮亮 付涛[1] 陈小兵[2] PI Liang;FU Tao;CHEN Xiao-bin(Zhoukou Central Hospital,Zhoukou 466700,China;Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]周口市中心医院,周口466700 [2]郑州大学,郑州450001

出　　处：《中国临床神经科学》2023年第5期533-540,共8页Chinese Journal of Clinical Neurosciences

基　　金：国家自然科学基金资助项目(编号:81472714)。

摘　　要：目的探讨改良后颅窝减压术治疗Ⅰ型Chiari畸形的临床疗效及对后颅窝形态学参数、颅颈交界区稳定性的影响。方法106例Ⅰ型Chiari畸形患者根据手术方法不同分为改良手术组(行改良后颅窝减压术,53例)、传统手术组(行传统后颅窝减压术,53例),比较两组手术一般评价指标(手术时间、术中出血量、住院时间、手术费用)、手术治疗效果[Karnofsky功能状态(KPS)评分、术后脊髓空洞变化、芝加哥Chiari畸形结局量表(CCOS)评分]、后颅窝形态学参数(延髓颈髓角、小脑扁桃体下疝长度、枕大池容积),血清GFAP、S100β、BDNF、NGF蛋白水平,颅颈交界区失稳率和并发症。结果改良手术组术中出血量和住院时间较传统手术组减少,术后6个月KPS评分、CCOS评分改善率高于传统手术组,术后6个月小脑扁桃体下疝长度低于传统手术组,枕大池容积高于传统手术组(P<0.05)。改良手术组术前、术后6个月GFAP、S100β、BDNF、NGF、颅颈交界区失稳率、并发症发生率与传统手术组比较(均P>0.05)。结论改良后颅窝减压术治疗Ⅰ型Chiari畸形下疝复位效果较好,可减少术中出血量和住院时间,有效缓解临床症状,促进功能状态恢复,且不影响颅颈交界区的稳定性,不增加神经损伤,安全可靠。Aim To investigate the clinical efficacy of modified posterior cranial fossa decompression for typeⅠChiari malformation and the effects on morphological parameters of the posterior cranial fossa and the stability of the craniocervical junction area.Methods One hundred and six patients with typeⅠChiari malformation were divided into a modified group(modified posterior cranial fossa decompression,53 cases)and a conventional group(conventional posterior cranial fossa decompression,53 cases)according to the surgical method,and the two groups were compared in terms of general evaluation indexes of surgery(operation time,intraoperative bleeding,hospital stay,operation cost),surgical treatment outcome[Karnofsky functional status(KPS)score,postoperative spinal cord cavity changes,changes in Chicago Chiari Deformity Outcome Scale(CCOS)scores],morphological parameters of the posterior cranial fossa(medullary cervical medullary angle,length of submicrocephalic tonsillar herniation,volume of the greater occipital pool),serum glial fibrillary acidic protein(GFAP),astrocytic collagen(S100β),brain-derived neurotrophic factor(BDNF),neurotrophic factor(NGF),and craniocervical junction area instability rate,complications.Results Intraoperative bleeding in the modified group was less than that in the traditional group,hospital stay was shorter than that in the traditional group,the improvement rate of KPS score and CCOS score at 6 months after surgery was higher than that in the traditional group,the length of subungual herniation of the cerebellum at 6 months after surgery was lower than that in the traditional group,and the volume of occipital pool was higher than that in the traditional group(P<0.05).The rates of GFAP,S100β,BDNF,NGF,craniocervical junction zone instability before and at 6 months after surgery in the modified group and complication rates were not statistically significant when compared with the traditional group(P>0.05).Conclusion Modified posterior cranial fossa decompression for typeⅠChiari malformation

关 键 词：改良后颅窝减压术 Ⅰ型Chiari畸形 临床疗效 后颅窝形态学 颅颈交界区稳定性 

分 类 号：R651.19[医药卫生—外科学]