后颅窝减压联合不同硬脑膜处理方式对Chiari畸形Ⅰ型患者预后的影响  

Influence of posterior cranial fossa decompression combined with various dural management techniques on the prognosis of Chiari malformation typeⅠ

作　　者：李丽丽[1] 陈鑫[1] 赵世光[1] 杨赫 Lili Li;Xin Chen;Shiguang Zhao;He Yang(Department of Neurosurgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院神经外科,哈尔滨150001

出　　处：《中华神经创伤外科电子杂志》2024年第4期206-212,共7页Chinese Journal Of Neurotraumatic Surgery:Electronic Edition

基　　金：黑龙江省自然科学基金优青项目(YQ2021H017)

摘　　要：目的比较Chiari畸形Ⅰ型(CM-Ⅰ)患者后颅窝减压后使用不同材质的人工硬膜行硬膜扩大成形术或硬膜外层切开术的短期疗效、术后并发症、手术时间及长期疗效。方法回顾性分析哈尔滨医科大学附属第一医院神经外科自2012年9月至2023年12月收治的169例CM-Ⅰ患者的临床资料,其中30例行后颅窝减压术+硬膜外层切开术(A组),139例行后颅窝减压术+硬膜扩大成形术(B组),包括61例使用主要成分是胶原蛋白的生物成分硬膜(B1组),59例使用主要成分是聚酯尿烷纤维的人工合成材料硬膜(B2组),19例使用主要成分是Polyglactin910缝线和聚二氧环己酮(PDO)无色缝线交织而成的人工硬膜(B3组)。比较4组患者的术后短期Tator评分、并发症、手术时间及长期预后。结果A组与B1组、B2组、B3组患者的术后短期有效率、好转率和并发症发生率比较,差异均无统计学意义(P>0.05)。A组患者的中位手术时间较B1组、B2组、B3组短,差异有统计学意义(P<0.05)。Chicago-Chiari预后量表评分和Tator评分的评估结果显示,A组的改善率、好转率均高于B1组、B2组、B3组,差异有统计学意义(P<0.05);而B1组、B2组、B3组比较,差异无统计学意义(P>0.05)。结论CM-Ⅰ患者后颅窝减压后行硬膜外层切开术比使用不同材质硬膜行扩大成形术的手术时间相对更短,长期疗效更好。Objective To compare the short-term efficacy,postoperative complications,operative time,and long-term outcomes of using different materials of artificial dura for duraplasty or outer dural layer incision after posterior fossa decompression in patients with Chiari malformation typeⅠ(CM-Ⅰ).Methods A retrospective analysis was performed on the clinical data of 169 patients with CM-I treated at Neurosurgery Department of the First Affiliated Hospital of Harbin Medical University from September 2012 to December 2023.Among them,30 patients underwent posterior fossa decompression+outer dural layer incision(group A),and 139 patients underwent posterior fossa decompression+duraplasty(group B),including 61 patients using collagen-based biological dura(group B1);59 patients using polyester urethane fiber synthetic dura(group B2);and 19 patients using artificial dura composed of Polyglactin910 sutures and Polydioxanone(PDO)sutures(group B3).The postoperative short-term Tator scores,complications,surgical time,and long-term prognosis of four groups were compared.Results There was no statistically significant difference in the short-term efficacy,improvement rate,and complication rates between group A and groups B1,B2,and B3(P>0.05).The median surgical time of group A was shorter than that of groups B1,B2,and B3,and the differences were statistically significant(P<0.05).The evaluation results of CCOS score and Tator score showed that the improvement rate and progression rate of group A were higher than those of groups B1,B2,and B3,and the differences were statistically significant(P<0.05);there was no statistically significant differences among the B1,B2,and B3 groups(P>0.05).Conclusion In CM-I patients,dural outer layer incision following posterior fossa decompression has a relatively shorter surgical time and better long-term outcomes compared to expanded duraplasty with different dural materials.

关 键 词：Chiari畸形Ⅰ型 后颅窝减压术 硬膜外层切开术 硬膜扩大成形术 人工硬膜 

分 类 号：R651.1[医药卫生—外科学]