CAJ | 학술논문

目的：观察3种手术方法治疗 Arnold - Chiari Ⅰ型畸形并脊髓空洞的疗效，为临床治疗提供参考。方法回顾性分析新疆维吾尔自治区人民医院神经外科2006年1月—2012年6月收治的113例 Arnold - Chiari Ⅰ型畸形并脊髓空洞患者的临床资料，A 组（16例）行单纯骨性减压，B 组（55例）行骨性减压＋硬膜扩大修补，C 组（42例）行骨性减压＋硬膜扩大修补＋小脑扁桃体切除。对比分析手术有效率、空洞闭合率及近期并发症发生率。结果术后随访6个月~2年，A、B、C 组分别随访12、45、36例患者。A、B、C 3组手术有效率分别为41.7%（5例）、91.1%（41例）、88.9%（32例），B、C 组有效率均高于 A 组，差异有统计学意义（P <0.05）。空洞闭合率分别为4例（33.3%）、36例（80.0%）、27例（75.0%），B、C 组空洞闭合率均高于 A 组，差异有统计学意义（P <0.05）。A、B、C 组术后切口感染发生率分别为12.5%（2例）、14.5%（8例）、14.2%（6例），术后一过性头痛发生率分别为37.5%（6例）、54.5%（30例）、59.5%（25例），差异均无统计学意义（χ2=0.044、0.276，P >0.05）；B、C术后早期脑脊液漏并皮下积液发生率分别为27.3%（15例）、31.0%（13例），A 组为0。C 组死亡1例。结论骨性减压＋硬膜扩大修补减压与骨性减压＋硬膜扩大修补减压＋小脑扁桃体切除手术疗效相当，有效率高，并发症发生率低，整体效果优于单纯骨性减压，是治疗 Arnold - Chiari Ⅰ畸形并脊髓空洞值得推荐的方法。
목적：관찰3충수술방법치료 Arnold - Chiari Ⅰ형기형병척수공동적료효，위림상치료제공삼고。방법회고성분석신강유오이자치구인민의원신경외과2006년1월—2012년6월수치적113례 Arnold - Chiari Ⅰ형기형병척수공동환자적림상자료，A 조（16례）행단순골성감압，B 조（55례）행골성감압＋경막확대수보，C 조（42례）행골성감압＋경막확대수보＋소뇌편도체절제。대비분석수술유효솔、공동폐합솔급근기병발증발생솔。결과술후수방6개월~2년，A、B、C 조분별수방12、45、36례환자。A、B、C 3조수술유효솔분별위41.7%（5례）、91.1%（41례）、88.9%（32례），B、C 조유효솔균고우 A 조，차이유통계학의의（P <0.05）。공동폐합솔분별위4례（33.3%）、36례（80.0%）、27례（75.0%），B、C 조공동폐합솔균고우 A 조，차이유통계학의의（P <0.05）。A、B、C 조술후절구감염발생솔분별위12.5%（2례）、14.5%（8례）、14.2%（6례），술후일과성두통발생솔분별위37.5%（6례）、54.5%（30례）、59.5%（25례），차이균무통계학의의（χ2=0.044、0.276，P >0.05）；B、C술후조기뇌척액루병피하적액발생솔분별위27.3%（15례）、31.0%（13례），A 조위0。C 조사망1례。결론골성감압＋경막확대수보감압여골성감압＋경막확대수보감압＋소뇌편도체절제수술료효상당，유효솔고，병발증발생솔저，정체효과우우단순골성감압，시치료 Arnold - Chiari Ⅰ기형병척수공동치득추천적방법。
Objectjve To investigate the efficacy of three operation methods in the treatment of Arnold - Chiari Ⅰmalformation with syringomyelia and provide references for clinical treatment. Methods Retrospective analysis was conducted on 113 patients with Arnold - Chiari Ⅰ malformation and syringomyelia who were admitted into the Department of Neurosurgery of People′s Hospital of Xinjiang Uygur Autonomous Region from January 2006 to June 2012. The included patients were divided into three groups:group A( n = 16 ),group B( n = 55 ) and group C( n = 42 ). Group A was treated with pure bony decompression;group B was treated with bony decompression plus dural enlargement repair;group C was treated with bony decompression plus dural enlargement repair and resection of cerebellar tonsils. Operation effective rate,incidence of the operation complications shortly after surgery and spinal cord cavity closure rate were compared among the three groups. Results A,B,C group were 12,45,46 patients followed up for 6 months - 2 years. The operation effective rates of group A,B and C were 41. 7% (5 cases),91. 1%(41 cases)and 88. 9% (32 cases),with group B and group C significantly higher(P <0. 05)than group A. The spinal cord cavity closure rates of group A,B and C were 33. 3% (4 cases),80. 0% (36 cases) and 75. 0% (27 cases),with group B and group C significantly higher(P < 0. 05)than group A. The incision infection rates of group A,B and C were 12. 5% (2 cases),14. 5% (8 cases)and 14. 2% (6 cases)and the transient headache rates were 37. 5% (6 cases),54. 5% (30 cases),59. 5% (25 cases),with no significant differences( χ2 = 0. 044,0. 276;P >0. 05). The rates of early leakage of cerebrospinal fluid with subcutaneous hydrops of group A and B were 27. 3% (15 cases) and 31. 0% (13 cases)and it was not noted in group A. One patient of group C died. Conclusjon Bony decompression plus dural enlargement repair and bony decompression plus dural enlargement repair and resection of the cerebellar tonsils have similar effects with high effective rates,low complication rates and better overall effects than pure bony decompression. The two operation methods are recommendable for the treatment of Arnold - Chiari Ⅰ malformation with syringomyelia.