CAJ | 학술논문

目的评估Chiari畸形/脊髓空洞患者后颅窝减压术(PFD)后脊柱侧凸的自然进展并分析影响侧凸转归的相关因素.方法对2002年1月至2007年12月期间南京大学医学院附属鼓楼医院脊柱外科PFD治疗的26例Chiari畸形/脊髓空洞伴脊柱侧凸患者的影像学资料进行回顾性分析,记录PFD术前及末次随访时主弯Cobb角、弯型、矢状面参数(胸椎后凸、胸腰段交界后凸、腰椎前凸)、小脑扁桃体下疝程度、空洞大小及长度.定义末次随访Cobb角小于或等于行后颅窝减压术时5°为侧凸未进展(未进展组),大于行后颅窝减压术时5°以上为侧凸进展(进展组).运用成组设计资料t检验和Fisher精确检验比较两组PFD术前各项参数间的差异.结果 26例患者接受PFD手术时平均年龄6.5 ～14.7(10.3±2.4)岁,主弯Cobb角20 ～45(33.5±7.7)°.术后24～118(57.5±26.9)个月随访时,11例(42％)患者脊柱侧凸获得稳定或改善.进展组平均初始年龄显著大于非进展组(11.1±2.2)比(9.2±2.2)岁,P=0.041,此外进展组中胸腰双弯比例显著高于非进展组(26.7％比9.1％,P=0.037).而Cobb角、Risser征、矢状面参数、小脑扁桃体下疝程度、空洞大小及长度、术前伴神经症状/体征比例在两组间差异均无统计学意义(均P ＞0.05).结论后颅窝减压术后42％的Chiari畸形/脊髓空洞患者可获得脊柱侧凸的稳定或改善.PFD手术时年龄较大、胸腰双弯弯型可能是术后脊柱侧凸进展的危险因素.
목적 평고Chiari기형/척수공동환자후로와감압술(PFD)후척주측철적자연진전병분석영향측철전귀적상관인소.방법 대2002년1월지2007년12월기간남경대학의학원부속고루의원척주외과PFD치료적26례Chiari기형/척수공동반척주측철환자적영상학자료진행회고성분석,기록PFD술전급말차수방시주만Cobb각、만형、시상면삼수(흉추후철、흉요단교계후철、요추전철)、소뇌편도체하산정도、공동대소급장도.정의말차수방Cobb각소우혹등우행후로와감압술시5°위측철미진전(미진전조),대우행후로와감압술시5°이상위측철진전(진전조).운용성조설계자료t검험화Fisher정학검험비교량조PFD술전각항삼수간적차이.결과 26례환자접수PFD수술시평균년령6.5 ～14.7(10.3±2.4)세,주만Cobb각20 ～45(33.5±7.7)°.술후24～118(57.5±26.9)개월수방시,11례(42％)환자척주측철획득은정혹개선.진전조평균초시년령현저대우비진전조(11.1±2.2)비(9.2±2.2)세,P=0.041,차외진전조중흉요쌍만비례현저고우비진전조(26.7％비9.1％,P=0.037).이Cobb각、Risser정、시상면삼수、소뇌편도체하산정도、공동대소급장도、술전반신경증상/체정비례재량조간차이균무통계학의의(균P ＞0.05).결론 후로와감압술후42％적Chiari기형/척수공동환자가획득척주측철적은정혹개선.PFD수술시년령교대、흉요쌍만만형가능시술후척주측철진전적위험인소.
Objective To explore the natural history of scoliosis after posterior fossa decompression (PFD) in patients with Chiari malformation/syringomyelia and examine the risk factors associated with curve progression.Methods A retrospective radiographic study was performed at our scoliosis center for 26patients undergoing PFD for Chiari malformation between January 2002 and December 2007.Their clinical and radiological parameters,including age,curve magnitude,curve pattern,extent of cerebelar tonsil herniation,maximal syrinx/cord ratio,syrinx size and length,were evaluated pre-and postoperatively.Curve progression was defined as an increment of Cobb angle over 5° compared with that of initial curve (progression group); whereas an increment of Cobb angle equal to or under 5° was considered curve stabilization or improvement (non-progression group).All aforementioned parameters at the time of PFD were compared between two groups with Student t and Fisher exact tests.Results Their average initial age,curve magnitude and follow-up duration were 10.3 ±2.4 (6.5-14.7) years,33.5° ±7.7° (20°-45°)and 57.5 ± 26.9 (24-118) months respectively.At the final follow-up,curve improvement or stabilization occurred in 11 (42％) patients.Compared with the non-progression group,significantly greater initial age was observed in the progression group (11.1 ± 2.2 vs 9.2 ± 2.2 years,P =0.041).In addition,the percentage of double major curve was significantly higher in the progression group than that in the nonprogression group (26.7％ vs 9.1％,P =0.037).With regards to Cobb angle,Risser sign,extent of cerebelar tonsil herniation,maximal syrinx/cord ratio,syrinx length,sagittal parameters and percentage of patients with preoperative neurological signs or symptoms,no significant differences existed between two groups (P ＞ 0.05).Conclusion PFD may halt curve progression in 42％ of patients with Chiari malformation/syringomyelia.And those with older age or double major curves are more likely to experience the progression of scoliosis during the post-PFD course.