联合手术治疗寰枕部畸形合并脊髓空洞症的效果分析  

Analysis of the effect of combined surgical treatment atlantooccipital malformation with syringomyelia

作　　者：戴志强 罗为 谢佳芯 刘羽阳 李杰 张鑫 邓洵鼎 曹宁 封亚平 Zhiqiang Dai;Wei Luo;Jiaxin Xie;Yuyang Liu;Jie Li;Xin Zhang;Xunding Deng;Ning Cao;Yaping Feng(Department of Neurosurgery,the 920th Hospital of PLA Joint Logistics Support Force,Kunming 650032,China;Department of Radiology,the First Affiliated Hospital of Army Medical University,Chongqing 400038,China)

机构地区：[1]解放军联勤保障部队第九二〇医院神经外科,昆明650032 [2]陆军军医大学第一附属医院放射科,重庆400038

出　　处：《中华神经创伤外科电子杂志》2024年第6期325-329,共5页Chinese Journal Of Neurotraumatic Surgery:Electronic Edition

基　　金：昆医联合专项(面上项目)(20230JAY070001-283)

摘　　要：目的分析颈椎固定术并后颅窝减压术联合脊髓空洞-蛛网膜下腔引流术治疗寰枕部畸形合并脊髓空洞症(SY)的临床效果。方法回顾性收集解放军联勤保障部队第九二〇医院神经外科自2017年1月至2024年5月行颈椎固定术并后颅窝减压术联合脊髓空洞-蛛网膜下腔引流术治疗的93例寰枕部畸形合并SY患者,对比分析患者手术前后的临床症状、脊髓空洞直径和体积变化以及影像学资料。结果患者术后头痛、头晕、颈肩部、上肢疼痛、麻木、肢体活动不灵、行走不稳、后组颅神经障碍、四肢肌力降低、感觉障碍等症状缓解明显,肌肉萎缩改善较少。术后患者的脊髓空洞最大前后直径、同平面脊髓前后直径、空洞脊髓比、空洞长度及空洞体积均较术前明显缩小,差异有统计学意义(P<0.05)。术后MRI示空洞体积明显改善82例(88.2%),改善10例(10.8%),无改善1例(1.1%)。结论颈椎固定术并后颅窝减压术联合脊髓空洞-蛛网膜下腔引流术治疗寰枕部畸形合并SY效果确切,安全性高。Objective To analyze the clinical effect of cervical spine fixation and posterior fossa decompression combined with syringomyelo-subarachnoid drainage in the treatment of atlantooccipital malformation with syringomyelia(SY).Methods A retrospective collection was conducted on 93 patients with atlantoaxial malformation combined with SY syndrome who underwent cervical spine fixation and posterior fossa decompression combined with syringomyelo-subarachnoid drainage in Neurosurgery Department of the 920th Hospital of PLA Joint Logistics Support Force from January 2017 to May 2024.The clinical symptoms,changes in SY diameter and volume,and imaging data before and after surgery were compared and analyzed.Results After the Combined surgical treatment,the patient&apos;s symptoms such as headache,dizziness,neck and shoulder pain,numbness,limb immobility,difficulty in moving limbs or unsteady walking,posterior cranial nerve disorders,decreased muscle strength in the limbs,and sensory impairment were significantly relieved,while muscle atrophy improved less.The maximum anterior posterior diameter of the SY,the anterior posterior diameter of the spinal cord in the same plane,the ratio of the cavity to the spinal cord,the length of the cavity,and the volume of the cavity in postoperative patients were significantly reduced compared with preoperative values,and the differences were statistically significant(P<0.05).Postoperative MRI showed significant improvement in cavity volume in 82 cases(88.2%),improvement in 10 cases(10.8%),and no improvement in 1 case(1.1%).Conclusion Cervical spine fixation and posterior fossa decompression combined with syringomyelo-subarachnoid drainage is effective and safe in treating atlantoaxial malformation with SY.

关 键 词：寰枕部畸形 脊髓空洞症 脊髓空洞-蛛网膜下腔分流术 

分 类 号：R651.2[医药卫生—外科学]