中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2014年
12期
940-943
,共4页
汪舟%朱泽章%邱勇%蒋健%钱邦平%沙士甫%谢丁丁%江龙
汪舟%硃澤章%邱勇%蔣健%錢邦平%沙士甫%謝丁丁%江龍
왕주%주택장%구용%장건%전방평%사사보%사정정%강룡
小脑%畸形%脊髓空洞症%颅窝,后%减压术,外科
小腦%畸形%脊髓空洞癥%顱窩,後%減壓術,外科
소뇌%기형%척수공동증%로와,후%감압술,외과
Cerebellum%Abnormalities%Syringomuelia%Cranial fossa,posterior%Decompression,surgical
目的 探讨青少年Chiari畸形伴脊髓空洞患儿后颅窝减压术(posterior fossa decompression,PFD)中施行空洞分流的必要性.方法 回顾性分析2005年6月至2009年12月间我院后颅窝减压术治疗的40例青少年Chiari畸形伴脊髓空洞症患儿,根据术中是否施行脊髓空洞-蛛网膜下腔分流分为PFD+空洞分流组(A组)与单纯PFD组(B组).其中,A组患儿18例,男6例,女12例,平均年龄13.5岁;B组患儿22例,男14例,女8例,平均年龄13.1岁.于T1加权MRI上测量术前及末次随访时空洞长度、最大脊髓空洞直径/脊髓直径值(S/C值),统计分析两组患儿的脊髓空洞改善程度是否存在差异.结果 术前两组患儿性别、年龄、空洞大小均无显著差异.A组随访时间12～33个月,平均(16.8±6.1)个月;B组随访时间12～25个月,平均(16.4±3.3)个月.末次随访时,两组患儿空洞长度(9.0±6.5)个椎体、S/C值0.56±0.28均较其术前(13.1±4.5)个椎体和0.78±0.07显著减小,差异有统计学意义(P＜0.05).A组平均空洞长度改善率、S/C值改善率分别为(34.4±37.5)％和(30.3±33.3)％;B组平均空洞长度改善率、S/C值改善率分别为(52.1±29.3)％和(41.2±31.2)％;组间比较差异没有统计学意义(P＞0.05).A组空洞长度改善值为(4.1±5.1)节段,B组为(5.9±4.4)节段;A组S/C改善值为0.22±0.23,B组为0.32±0.26,组间差异均无统计学意义(P＞0.05).结论 空洞分流术对行后颅窝减压术的青少年Chiari畸形患儿的空洞转归无明显影响,然而其远期疗效有待更大样本、更长随访时间的研究行进一步证实.
目的 探討青少年Chiari畸形伴脊髓空洞患兒後顱窩減壓術(posterior fossa decompression,PFD)中施行空洞分流的必要性.方法 迴顧性分析2005年6月至2009年12月間我院後顱窩減壓術治療的40例青少年Chiari畸形伴脊髓空洞癥患兒,根據術中是否施行脊髓空洞-蛛網膜下腔分流分為PFD+空洞分流組(A組)與單純PFD組(B組).其中,A組患兒18例,男6例,女12例,平均年齡13.5歲;B組患兒22例,男14例,女8例,平均年齡13.1歲.于T1加權MRI上測量術前及末次隨訪時空洞長度、最大脊髓空洞直徑/脊髓直徑值(S/C值),統計分析兩組患兒的脊髓空洞改善程度是否存在差異.結果 術前兩組患兒性彆、年齡、空洞大小均無顯著差異.A組隨訪時間12～33箇月,平均(16.8±6.1)箇月;B組隨訪時間12～25箇月,平均(16.4±3.3)箇月.末次隨訪時,兩組患兒空洞長度(9.0±6.5)箇椎體、S/C值0.56±0.28均較其術前(13.1±4.5)箇椎體和0.78±0.07顯著減小,差異有統計學意義(P＜0.05).A組平均空洞長度改善率、S/C值改善率分彆為(34.4±37.5)％和(30.3±33.3)％;B組平均空洞長度改善率、S/C值改善率分彆為(52.1±29.3)％和(41.2±31.2)％;組間比較差異沒有統計學意義(P＞0.05).A組空洞長度改善值為(4.1±5.1)節段,B組為(5.9±4.4)節段;A組S/C改善值為0.22±0.23,B組為0.32±0.26,組間差異均無統計學意義(P＞0.05).結論 空洞分流術對行後顱窩減壓術的青少年Chiari畸形患兒的空洞轉歸無明顯影響,然而其遠期療效有待更大樣本、更長隨訪時間的研究行進一步證實.
목적 탐토청소년Chiari기형반척수공동환인후로와감압술(posterior fossa decompression,PFD)중시행공동분류적필요성.방법 회고성분석2005년6월지2009년12월간아원후로와감압술치료적40례청소년Chiari기형반척수공동증환인,근거술중시부시행척수공동-주망막하강분류분위PFD+공동분류조(A조)여단순PFD조(B조).기중,A조환인18례,남6례,녀12례,평균년령13.5세;B조환인22례,남14례,녀8례,평균년령13.1세.우T1가권MRI상측량술전급말차수방시공동장도、최대척수공동직경/척수직경치(S/C치),통계분석량조환인적척수공동개선정도시부존재차이.결과 술전량조환인성별、년령、공동대소균무현저차이.A조수방시간12～33개월,평균(16.8±6.1)개월;B조수방시간12～25개월,평균(16.4±3.3)개월.말차수방시,량조환인공동장도(9.0±6.5)개추체、S/C치0.56±0.28균교기술전(13.1±4.5)개추체화0.78±0.07현저감소,차이유통계학의의(P＜0.05).A조평균공동장도개선솔、S/C치개선솔분별위(34.4±37.5)％화(30.3±33.3)％;B조평균공동장도개선솔、S/C치개선솔분별위(52.1±29.3)％화(41.2±31.2)％;조간비교차이몰유통계학의의(P＞0.05).A조공동장도개선치위(4.1±5.1)절단,B조위(5.9±4.4)절단;A조S/C개선치위0.22±0.23,B조위0.32±0.26,조간차이균무통계학의의(P＞0.05).결론 공동분류술대행후로와감압술적청소년Chiari기형환인적공동전귀무명현영향,연이기원기료효유대경대양본、경장수방시간적연구행진일보증실.
Objective To evaluate the necessity of syrinx shunting in adolescents undergoing posterior fossa decompression (PFD) for Chiari malformation and syringomyelia.Methods A total of 40 patients,aged 10 to 18 years,undergoing PFD for Chiari malformation between June 2005 and December 2009 were identified and retrospectively reviewed.They were classified into 2 groups based on whether or not shunting was performed:group A with PFD plus syrinx shunting (M∶F =6∶ 12;mean age,13.5 years) and group B with PFD alone (M∶ F =14∶ 8; mean age,13.1 years).On T1-weighted magnetic resonance imaging,syrinx length as well as maximal syrinx/cord (S/C) ratio was evaluated pre-and postoperatively.The extent of syrinx resolution was compared between two groups with Student's t test.Results During PFD,age,gender,syrinx length and S/C ratio did not differ significantly between two groups (P＞0.05).The average follow-up periods of groups A and B were 16.8 ± 6.1 (12-33)and 16.4 ± 3.3(12-25)months respectively.At the last follow-up,syrinx length and maximal S/C ratio decreased significantly in both groups (P＜0.05).The improvement rate of syrinx length and S/C ratio averaged 0.34 ± 0.37 and 0.30 ± 0.33 for Group A versus 0.52 ± 0.29 and 0.41 ± 0.31 for Group B respectively.No significant inter-group differences existed in the extent of improvement in syrinx length or S/C ratio (P＞0.05).Conclusions In neurosurgical treatment of syringomyelia associated with Chiari malformation,syrinx shunting plus PFD shows no advantage over PFD alone in terms of decreasing syrinx length or S/C ratio.
