CAJ | 학술논문

目的测量青少年Chiari畸形伴脊髓空洞患者后颅窝减压(PFD)手术前后延髓及小脑的位置,并分析其变化趋势与空洞转归之间的相关性.方法回顾性分析2006年9月至2011年9月接受治疗并符合入选标准的46例青少年Chiari畸形伴脊髓空洞患者的资料,其中男性25例,女性21例；年龄10～17岁,平均(13.9±1.9)岁.患者随访时间6～52个月,平均(13±12)个月.在正中矢状位MRI上测量术前及末次随访时的延髓脑桥沟、第四脑室顶点、小脑扁桃体下端的纵向及横向位置、延髓脊髓角、空洞的最大前后径与同水平处脊髓前后径的比值(S/C最大比值)及空洞的长度.采用配对样本t检验分析PFD前后上述指标间的差异,使用双变量相关性分析具有统计学差异的指标的变化值与空洞改善之间的相关性.结果 PFD术后31例(67.4％)患者延髓脑桥沟向上方移位,35例(76.0％)患者小脑扁桃体下端向上方移位.40例(86.9％)患者脊髓空洞改善,S/C最大比值、脊髓空洞长度在PFD手术前后的差异具有统计学意义(t=7.114和7.816,P=0.000),S/C最大比值及空洞长度的改善率分别为32％±30％和43％±33％.延髓脑桥沟的上移(r =0.332,P=0.027)、小脑扁桃体下端的上移(r=0.298,P=0.044)与S/C最大比值改善率之间具有显著相关性.结论青少年Chiari畸形伴脊髓空洞患者PFD术后延髓脑桥沟及小脑扁桃体下端的上移对脊髓空洞的改善有促进作用.
목적 측량청소년Chiari기형반척수공동환자후로와감압(PFD)수술전후연수급소뇌적위치,병분석기변화추세여공동전귀지간적상관성.방법 회고성분석2006년9월지2011년9월접수치료병부합입선표준적46례청소년Chiari기형반척수공동환자적자료,기중남성25례,녀성21례；년령10～17세,평균(13.9±1.9)세.환자수방시간6～52개월,평균(13±12)개월.재정중시상위MRI상측량술전급말차수방시적연수뇌교구、제사뇌실정점、소뇌편도체하단적종향급횡향위치、연수척수각、공동적최대전후경여동수평처척수전후경적비치(S/C최대비치)급공동적장도.채용배대양본t검험분석PFD전후상술지표간적차이,사용쌍변량상관성분석구유통계학차이적지표적변화치여공동개선지간적상관성.결과 PFD술후31례(67.4％)환자연수뇌교구향상방이위,35례(76.0％)환자소뇌편도체하단향상방이위.40례(86.9％)환자척수공동개선,S/C최대비치、척수공동장도재PFD수술전후적차이구유통계학의의(t=7.114화7.816,P=0.000),S/C최대비치급공동장도적개선솔분별위32％±30％화43％±33％.연수뇌교구적상이(r =0.332,P=0.027)、소뇌편도체하단적상이(r=0.298,P=0.044)여S/C최대비치개선솔지간구유현저상관성.결론 청소년Chiari기형반척수공동환자PFD술후연수뇌교구급소뇌편도체하단적상이대척수공동적개선유촉진작용.
Objectives To evaluate the changes of the position of medulla oblongata and cerebellum following posterior fossa decompression (PFD),and to investigate their influences on the prognosis of the syringomyelia in adolescents with Chiari malformation (CM).Methods A retrospective review was performed on all CM patients between September 2006 and September 2011.A subset of 46 patients,including 25 male and 21 female patients,was finally enrolled according to the inclusion criteria.The initial age and duration of follow-up averaged 13.9 years (range,10-17 years) and 13 months (range,6-52 months),respectively.On mid-sagittal MRI,the following parameters were evaluated pre-and postoperatively (follow-up≥6 months):the longitudinal and transverse position of bulbopontine sulcus,the fourth ventricle vertex,the lower extreme of cerebella tonsil,the cervico-medullary angle,the maximal syrinx/cord(S/C) ratio and the syrinx length.Changes in these parameters were analysed using the paired samples t test,and for these reaching statistical significances,an additional bivariate correlation analysis was performed to investigate their relation with syrinx resolution.Results At the latest follow-up,upward shifting of the bulbopontine sulcus was observed in 31 patients (67.4％),with upward shifting of the lower extreme of cerebella tonsil presenting in 35 patients(76.0％).The maximal S/C ratio and the syrinx length were significantly improved postoperatively (t =7.114 and 7.816,P =0.000).Significant resolution of the syrinx was demonstrated in 40 patients(86.9％),and more specifically,the average improvement rates of the maximal S/C ratio and the syrinx length were 32％ ± 30％ and 43％ ± 33％,respectively.In addition,the bivariate correlation analysis revealed that syrinx resolution was significantly correlated with the upward shifting of the bulbopontine sulcus (r =0.332,P =0.027) and lower extreme of cerebella (r =0.298,P =0.044).Conclusion The upward shifting of the bulbopontine sulcus and the lower extreme of cerebella tonsil might be implicated in the mechanisms of postoperative syrinx resolution.