CAJ | 학술논문

目的观察三种手术方法治疗ChiariⅠ畸形并脊髓空洞疗效.方法总结新疆维吾尔自治区人民医院神经外科2005年6月至2012年6月133例ChiariⅠ畸形并脊髓空洞患者,A组行单纯骨性减压20例;B组行骨性减压+硬膜扩大修补65例;C组行骨性减压+硬膜扩大修补+小脑扁桃体切除48例.对比三组手术效果、脊髓空洞消退情况及术后近期并发症发生率.结果门诊随访6个月至9年,共随访到118例患者,按Tator疗效标准,A、B、C三组优、良、差率比较的差异有统计学意义(P＜0.05),脊髓空洞消退对比的差异有统计学意义(P＜0.05),B和C组手术效果相似,均优于A组.A、B、C三组术后切口感染分别为1例、2例、1例,术后一过性头痛分别为6例、30例、23例,术后早期脑脊液漏并皮下积液分别为0例、8例、6例,C组死亡1例,总并发症的差异无统计学意义(P＞0.05).结论骨性减压+硬膜扩大修补是治疗ChiariⅠ畸形并脊髓空洞可靠方法之一,它与骨性减压+硬膜扩大修补+小脑扁桃体切除手术疗效相当,优于单纯骨性减压.
목적 관찰삼충수술방법치료ChiariⅠ기형병척수공동료효.방법 총결신강유오이자치구인민의원신경외과2005년6월지2012년6월133례ChiariⅠ기형병척수공동환자,A조행단순골성감압20례;B조행골성감압+경막확대수보65례;C조행골성감압+경막확대수보+소뇌편도체절제48례.대비삼조수술효과、척수공동소퇴정황급술후근기병발증발생솔.결과 문진수방6개월지9년,공수방도118례환자,안Tator료효표준,A、B、C삼조우、량、차솔비교적차이유통계학의의(P＜0.05),척수공동소퇴대비적차이유통계학의의(P＜0.05),B화C조수술효과상사,균우우A조.A、B、C삼조술후절구감염분별위1례、2례、1례,술후일과성두통분별위6례、30례、23례,술후조기뇌척액루병피하적액분별위0례、8례、6례,C조사망1례,총병발증적차이무통계학의의(P＞0.05).결론 골성감압+경막확대수보시치료ChiariⅠ기형병척수공동가고방법지일,타여골성감압+경막확대수보+소뇌편도체절제수술료효상당,우우단순골성감압.
Objective To investigate effects of three operation methods in treatment of Chiari Ⅰ with syringomyelia.Methods Retrospective study of patients betwenJune 2005 and June 2012 in The department of Neurosurgery,People's Hospital of Xinjiang Uygur Autonomous Region for a total of 133 cases patient of Chiari Ⅰ malformation with syrigomyelia.Group A was performed in 20 cases for simple posterior bony decompression; group B was performed in 65 cases for posterior bony decompression + dural enlargement repair;group C was performed in 48 cases for posterior bony decompression + dural enlargement repair + resection of the cerebellar tonsils.To comparison the effect of the operation,syringomyelia resolution and the rate of postoperative complications.Results Outpatient follow up for 6 months-9 years,a total of 118 patients were followed up for.According to the criteria of Tator,A,B,C three groups in the superior,good,poor rate was significant difference (P ＜ 0.05).Promote syringomyelia regression had significant difference(P ＜0.05).Group B and C have the same effect of operation,better than group A.A,B,C three groups of infection were 1 case,2 cases,1 case; postoperative transient headache were 6 cases,30 cases,25 cases;early postoperative cerebrospinal fliud leakage and subcutaneous effusion were 0 case,8 cases,6 cases ; 1 case of death in group C.The total complication rate had no significant difference (P ＞ 0.05).Conclusion Posterior bony decompression plus dural enlargement repair,posterior bony decompression withdural enlargement repair andResection of the cerebellar tonsils were the same effect,arereliable methods for Chiari Ⅰ with syringomyelia,better than soly posterior bony decompression.