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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

22卷

期数:

2016年04期

页码:

314-317

栏目:

临床医学

出版日期:

2016-07-19

文章信息/Info

Title:

Curative effect of modified posterior fossa decompression surgery in treatment of Chiari type I malformation

文章编号:

1006-8147（2016）04-0314-04

作者:

?何 平¹; 陈旨娟²; 赵景旺¹; 贾 源¹; 刘 龙¹; 李梦琦¹; 张建宁²; 岳树源¹; 王增光²; 杨卫东

(1.天津医科大学总医院神经外科,天津 300052;2.天津市神经病学研究所,天津 300052)

Author(s):

HE Ping¹;  CHEN Zhi-juan²;  ZHAO Jing-wang¹;  JIA Yuan¹;  LIU Long¹;  LI Meng-qi¹;  ZHANG Jian-ning²;  YUE Shu-yuan¹;  WANG Zeng-guang²;  YANG Wei-dong¹

(1.Department of Neurosurgery, General Hospital, Tianjin Medical University, Tianjin 300052, China;2. Tianjin Neurological Institute, Tianjin 300052, China)

关键词:

hiari畸形Ⅰ型; 脊髓空洞症; 改良后颅窝减压术; 并发症

Keywords:

">

Chiari type Ⅰ malformation' target="_blank" rel="external">">Chiari type Ⅰ malformation;  syringomyelia;  operation;  complication

?

分类号:

R651

DOI:

-

文献标志码:

A

摘要:

目的：探讨改良后颅窝减压术治疗Chiari畸形Ⅰ型的临床疗效和预后。方法：回顾性分析98例Chiari畸形Ⅰ型患者的临床资料，将48例改良手术治疗组（枕骨大孔区减压，硬膜外层松解）与50例对照组（传统术式治疗组，即后颅窝减压，硬脑膜成形，蛛网膜粘连松解，小脑扁桃体下疝切除）对比，观察评估患者术后短期和远期临床表现、并发症及影像学改善情况。结果：术后短期随访，两组临床表现改善情况差异无统计学意义（P>0.05），改良组脑脊液漏等并发症少于对照组（P<0.05）；术后远期随访，两组临床表现改善情况差异有统计学意义（P<0.05），改良组临床表现改善情况为73.2%，对照组51.1%；影像学改善情况差异无统计学意义（P>0.05）。结论：改良后颅窝减压术治疗Chiari畸形Ⅰ型是有效的，临床表现改善较为明显，且脑脊液漏等并发症较少。

Abstract:

?Objective: To investigate the effect and prognosis of modified surgical treatment of type ⅠChiari malformation. Methods: A retrospective study was to compare the improvement group, 48 patients (the decompression of the foramen magnum, release of epidural) and the control group, 50 patients (the traditional surgery, the decompression of posterior cranial fossa, dura plastic repair, release of spider adhesion, resection of cerebellar herniation) in the neurosurgery department. To the short-term and long-term improvement of the clinical manifestation, complications and imaging after operations were observed and evaluated. Results: There was no statistical significance between the two groups in the improvement of clinical manifestations in the short term follow-up (P>0.05), and the number of complications on cerebrospinal fluid leakages in the modified group was lower than the control (P<0.05). The rate of clinical improvement in the improvement group was 73.2% and 51.1% in the control group in the long term follow-up (P<0.05), Indicating significant differences in the clinical improvement. The differences of two groups in the radiologic improvement were not statistically significant (P>0.05). Conclusion: The modified posterior fossa decompression surgery in treatment of Chiari typeⅠmalformation is efficient, which remarkably may improve the clinical manifestation with less complications.

参考文献/References:

[1]Tator C H, Meguro K, Rowed D W. Favorable results with syringosubarachnoid shunts for treatment of syringomyelia[J]. J Neurosurg,1982,56(4):517
[2]Aboulezz A O, Sartor K, Geyer C A, et al. Position of cerebellar tonsils in the normal population and in patients with Chiari malformation: a quantitative approach with Mr imaging[J]. J Comput Assist Tomogr,1985,9(6):1033
[3]Urbizu A, Poca M A, Vidal X, et al. MRI-based morphometric analysis of posterior cranial fossa in the diagnosis of chiari malformation type I[J]. J Neuroimaging,2014,24(3):250
[4]Heiss J D, Suffredini G, Bakhtian K D, et al. Normalization of hindbrain morphology after decompression of Chiari malformation Type I[J]. J Neurosurg,2012,117(5):942
[5]黄思庆，肖启华，李国平，等. Arnold-Chiari畸形合并脊髓空洞症的显微外科治疗310例临床分析[J].中华神经外科杂志,2005,21(2):100
[6]Noudel R, Gomis P, Sotoares G, et al. Posterior fossa volume increase after surgery for Chiari malformation Type I: a quantitative assessment using magnetic resonance imaging and correlations with the treatment response[J].J Neurosurg,2011,115(3):647
[7]Josephson A, Greitz D, Klason T, et al. A spinal thecal sac constriction model supports the theory that induced pressure gradients in the cord cause edema and cyst formation[J]. Neurosurgery,2001,48(3):636-645; discussion 645
[8]Sacco D, Scott R M. Reoperation for chiari malformations[J]. Pediatr Neurosurg,2003,39(4):171
[9]Mazzola C A, Fried A H. Revision surgery for Chiari malformation decompression[J]. Neurosurg Focus,2003,15(3):1
[10]Rocque B G, George T M, Kestle J, et al. Treatment practices for Chiari malformation type I with syringomyelia: results of a survey of the American Society of Pediatric Neurosurgeons[J]. J Neurosurg Pediatr,2011,8(5):430
[11]Shaffer N, Martin B, Loth F. Cerebrospinal fluid hydrodynamics in type I Chiari malformation[J]. Neurol Res,2011,33(3):247
[12]Linge S O, Mardal K A, Helgeland A, et al. Effect of craniovertebral decompression on CSF dynamics in Chiari malformation type I studied with computational fluid dynamics: Laboratory investigation[J]. J Neurosurg Spine,2014,21(4):559
[13]Sakushima K, Hida K, Yabe I, et al. Different surgical treatment techniques used by neurosurgeons and orthopedists for syringomyelia caused by Chiari I malformation in Japan[J]. J Neurosurg Spine,2013,18(6):588
[14]Wu T, Zhu Z, Jiang J, et al. Syrinx resolution after posterior fossa decompression in patients with scoliosis secondary to Chiari malformation type I[J]. Eur Spine J,2012,21(6):1143
[15]Bao C, Yang F, Liu L, et al. Surgical treatment of Chiari I malformation complicated with syringomyelia[J]. Exp Ther Med,2013,5(1):333
[16]Clarke E C, Stoodley M A, Bilston L E. Changes in temporal flow characteristics of CSF in Chiari malformation Type I with and without syringomyelia: implications for theory of syrinx development[J]. J Neurosurg,2013,118(5):1135
[17]Di L N, Palma L, Palatinsky E, et al.“ Conservative” cranio-cervical decompression in the treatment of syringomyelia-Chiari I complex.A prospective study of 20 adult cases[J]. Spine(Phila Pa 1976), 1995,20(23):2479
[18]张晨，岳树源，张建宁. 硬膜外与硬膜下手术治疗 Chiari Ⅰ型畸形合并脊髓空洞的疗效比较[J]. 山东医药,2015,55(4):84
[19]王增光，胡震，杨卫东，等. 显微外科治疗小脑扁桃体下疝畸形Ⅰ型合并脊髓空洞症[J]. 中华显微外科杂志,2008,31(2):148
[20]Wang Y, Xie J, Zhao Z, et al. Changes in CSF flow after one-stage posterior vertebral column resection in scoliosis patients with syringomyelia and Chiari malformation type I[J]. J Neurosurg Spine,2013,18(5):456

相似文献/References:

备注/Memo

备注/Memo:

作者简介 何平（1989-），男，硕士在读，研究方向：神经外科学；通信作者：王增光，E-mail：wzgforrest@163.com；杨卫东，E-mail： yangweidongshine@sina.com。

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更新日期/Last Update: 2016-07-13