摘要
目的探讨后颅窝减压联合硬脑膜重建对治疗Chiari畸形Ⅰ型(CM-Ⅰ)合并脊髓空洞症(SM)的手术效果。方法回顾性分析延安大学咸阳医院2019年6月至2021年1月诊治的50例CM-Ⅰ合并SM患者的临床资料,根据手术方式分为研究组(27例)和对照组(23例),研究组行后颅窝减压联合硬脑膜重建术,对照组行单纯后颅窝减压术。比较两组手术前后临床症状改善情况、神经功能、脑脊液动力学指标变化和脊髓空洞变化,并统计术后并发症发生情况。结果两组总体临床症状好转率比较差异无统计学意义(P>0.05)。研究组术后疼痛、感觉障碍、运动障碍和共济失调评分高于对照组[(4.56±0.35)分比(4.28±0.43)分、(3.61±0.82)分比(3.15±0.73)分、(3.81±0.44)分比(3.59±0.50)分、(4.43±0.41)分比(4.09±0.53)分],差异有统计学意义(P<0.05)。研究组术后脑脊液每搏输出量、平均流量高于对照组[(0.05±0.02)ml比(0.04±0.01)ml、(0.05±0.01)ml/s比(0.04±0.01)ml/s],头、尾端最大峰值流速低于对照组[(3.14±1.05)mm/s比(3.87±1.13)mm/s、(5.56±1.38)mm/s比(6.43±1.22)mm/s],差异均有统计学意义(P<0.05)。两组患者术后脊髓空洞缩小或消失率、无变化率以及增大率比较差异无统计学意义(P>0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论后颅窝减压联合硬脑膜重建术应用于CM-Ⅰ合并SM,可更好地改善脑脊液动力学,同时可促进脊髓空洞的缩小,不增加术后并发症。
Objective To investigate the clinical effect of posterior fossa decompression combined with dural reconstruction in the treatment of Chiari malformation-Ⅰ(CM-Ⅰ)complicated with syringomyelia(SM).Methods The clinical data of 50 patients with CM-Ⅰcomplicated with SM who were treated in Yan′an University Xianyang Hospital from June 2019 to January 2021 were analyzed.They were divided into the study group(27 cases)and the control group(23 cases)according to the surgical methods.The former received posterior fossa decompression combined with dural reconstruction,while the latter received posterior fossa decompression alone.The clinical symptom improvement,neurological function,cerebrospinal fluid dynamics and syringomyelia changes were compared between the two groups before and after the surgery,and postoperative complications were compared.Results The overall clinical symptom improvement rate between the two groups had no significant difference(P>0.05).After the surgery,the scores of pain,sensory disturbance,dyskinesia and ataxia in the study group were higher than those in the control group:(4.56±0.35)points vs.(4.28±0.43)points,(3.61±0.82)points vs.(3.15±0.73)points,(3.81±0.44)points vs.(3.59±0.50)points,(4.43±0.41)points vs.(4.09±0.53)points,there were statistical significant(P<0.05).After the surgery,the cerebrospinal fluid stroke volume(SV)and mean flow(MF)in the study group were higher than those in the control group:(0.05±0.02)ml vs.(0.04±0.01)ml,(0.05±0.01)ml/s vs.(0.04±0.01)ml/s;the maximum peak flow velocity(Vmax)of the head and tail in the study group were lower than those in the control group:(3.14±1.05)mm/s vs.(3.87±1.13)mm/s,(5.56±1.38)mm/s vs.(6.43±1.22)mm/s,there were statistical significant(P<0.05).There were no significant differences in the rate of reduction or disappearance of syringomyelia,the rate of no change and the rate of increase of syringomyelia after the surgery between the two groups(P>0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusions Posterior fossa decompression combined with dural reconstruction in CM-Ⅰcomplicated with SM can better improve cerebrospinal fluid dynamics,and promote the reduction of syringomyelia without increasing postoperative complications.
作者
王鑫超
刘增强
巨涛
岳新鹏
李鑫
雷鹏飞
亓乾伟
Wang Xinchao;Liu Zengqiang;Ju Tao;Yue Xinpeng;Li Xin;Lei Pengfei;Qi Qianwei(Department of Neurosurgery,Yan′an University Xianyang Hospital,Xianyang 712000,China)
出处
《中国医师进修杂志》
2022年第10期922-926,共5页
Chinese Journal of Postgraduates of Medicine
