摘要
目的探讨小骨窗后颅窝减压加枕颈植骨融合内固定术治疗Chiari畸形合并颅底凹陷的手术效果。方法回顾性分析2006-2010年收治的16例Chiari畸形合并颅底凹陷患者,其中男7例,女9例,年龄17～65岁,平均36.4岁。所有患者均经影像学确诊,手术采取小骨窗后颅窝减压,小脑扁桃体切除,一期取自体髂骨行颈枕植骨融合钢丝内固定,术后行颈托固定3个月。结果所有患者术后症状均明显改善,无感染或死亡,1例出现引流口脑脊液漏,1例出现一过性肩胛区和胸胁部疼痛,未经治疗自行消失。术后随访6个月,按Symon和Lavender临床标准,治愈6例,好转9例,无效1例。复查MRI显示重建枕大池清晰,无小脑下垂发生,植骨已融合。结论小骨窗后颅窝减压加枕颈植骨融合钢丝内固定术治疗Chiari畸形合并颅底凹陷效果确切,在增加后颅窝容积同时可减轻脑干腹侧受压,并能重建颅颈交界区稳定性。
Objective To evaluate the therapeutic effect of small craniotomic posterior fossa decompression combined with occipital-cervical bone graft fusion and internal fixation on Chiari malformation complicated with basilar impression.Methods The clinical data of 16 cases（7 males and 9 females,aged 17 to 65 years,mean 36.4） of Chiari malformation complicated with basilar impression from 2006 to 2010 were retrospectively analyzed.The diagnoses for all the patients were confirmed by radiology.Small craniotomic posterior fossa decompression was performed in all patients,cerebellar tonsils were resected,and then one-stage occipital-cervical bone graft fusion using autogenous iliac bone and internal wiring fixation were performed.Neck support was used for 3 months after surgery.Results Symptoms were significantly improved in all cases after surgical operation.No patient died or infected.Cerebrospinal fluid leakage was found at draining site in one case.Transient pain of scapular and chest was found in one case and disappeared spontaneously.A 6-months follow-up showed that 6 patients were cured,9 improved and 1 unchanged according to Symon and Lavender standard.Postoperative MRI showed the reconstructed cisterna magna was clear in all patients,no cerebellar ptosis was found,and the occipital-cervical graft bone was fused.Conclusion In patients with Chiari malformation complicated with basilar impression,small craniotomic posterior fossa decompression combined with one-stage occipital-cervical bone graft fusion and internal wiring fixation has a clear and definite effect,it can increase the volume of posterior fossa and alleviate the ventral brain stem compression simultaneously,and reconstruct the stability of cranio-cervical junction.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2011年第2期119-121,共3页
Medical Journal of Chinese People's Liberation Army
