摘要
目的探讨保留寰椎后弓的小骨窗减压、枕大池成形显微外科手术方法对小脑扁桃体下疝畸形Ⅰ型（chiari malformation typeⅠ,CMI）的临床治疗效果。方法我院于2013年3月-2014年6月对23例具有完整寰椎后弓的CMI病例,采用枕外粗隆下2 cm至颈2棘突上缘约5 cm后正中直切口,保留寰椎后弓的后颅窝小骨窗减压、枕大池成形术（探查四脑室底枕大池重建,小脑扁桃体下疝切除、硬脑膜扩大修补）,观察术后1周、3个月及远期疗效,并进行Karnofsky功能状态评分（Karnofsky performance status scale,KPS）。结果术后1周患者神经症状改善19例,4例无明显变化,平均KPS评分由术前53.5±9.8分提高到66.52±9.8分（P〈0.00）。术后3个月复查,6例患者痊愈,12例症状改善明显,3例缓解,1例症状无明显变化,1例加重,较术后1周改善情况有统计学差异（P〈0.03）。术后3个月KPS评分提高至85.2±14.7分（P〈0.00）。术后3个月~2年的随访中,小脑扁桃体下疝和脊髓空洞消失或明显缩小。结论保留寰椎后弓的小骨窗减压、枕大池成形术临床效果较好,是治疗CMI安全、有效的手术方法。
Objective To discuss the efficacy of microsurgical approaches of small-bone-window posterior fossa decompression and cisterna magna angioplasty with conserved posterior arch of arias in treatment of chiari malformation type I . Methods Twenty- three cases with arcus posterior atlantis in the treatment of CMI in Chinese PLA General Hospital from March 2013 to June 2014 were selected. Patients had undergone small-window posterior fossa decompression and cisterna magna angioplasty with conserved posterior arch of arias through posterior midline approach （from 2 cm under inion to 5 cm on C2 spinous processes）, and the cisterna magna was reconstructed, the cerebellar tonsil subpial was resected, and duraplasty was performed. The long-term efficacy was observed for 1 week and 3 months postoperatively, and KPS score was used to evaluate the conditions after operation. Results One week after operation, the neurological condition was improved in 19 cases, while 4 cases had no change. The average KPS score increased from （53.5 ± 9.8） preoperatively to （66.52 ± 9.8） postoperatively （P 〈 0.00）. And 3 months after operation, 6 cases were cured, 3 cases were relieved, 1 case had no change and 1 case was exacerbation, which was better than 1 week postoperative condition （P 〈 0.03）. The average KPS score of 3 months after operation increased to 85.2 ± 14.7 （P 〈 0.00）. Cerebellar tonsillar hernia and syringomyelia shrank or disappeared obviously within 2-year follow-up. Conclusion The microsurgical approaches of small-window posterior fossa decompression and cistern magna angioplasty with conserved posterior arch of atlas shows excellent efficacy and less complication in treating chiari malformation type I.
出处
《解放军医学院学报》
CAS
2015年第7期702-705,共4页
Academic Journal of Chinese PLA Medical School
