摘要
目的探究不同手术方式应用于ChiariⅠ畸形合并脊髓空洞症及寰枢椎脱位的临床效果。方法回顾性分析2019月至2021年5月期间于我院神经外科接受治疗的80例ChiariⅠ畸形合并脊髓空洞症及寰枢椎脱位患者的临床及随访资料。根据手术方案的不同,将接受后颅窝减压+寰枢椎复位内固定术的患者纳入常规组,接受改良寰枕减压+枕颈内固定术的患者纳入改良组。比较两组的手术指标、脊髓指标、芝加哥Chiari畸形预后量表(Chicago Chiari outcome scale,CCOS)评分和不良事件发生情况。结果改良组患者的术中出血量、手术时间和术后住院时间均少于常规组(t=8.725、10.815、6.064,P<0.05);改良组术后6个月的VD-max、VU-max、ADI和脊髓空洞直径均小于术前(t=16.889、29.478、17.689、16.841,P<0.05),常规组术后6个月的VD-max、VU-max、ADI和脊髓空洞直径也均小于术前(t=17.661、28.954、17.314、16.547,P<0.05);而两组术前、术后6个月各指标相比则无差异(P>0.05)。改良组和常规组术后6个月的CCOS评分较术前均显著增加(t=55.520、138.323,P<0.05);而两组术前、术后6个月的CCOS评分相比则无差异(P>0.05);改良组不良事件发生率3.2%低于常规组20.4%(χ^(2)=4.727,P<0.05)。结论改良寰枕减压术+枕颈内固定术能够有效改善ChiariⅠ畸形合并脊髓空洞症及寰枢椎脱位患者的脊髓指标,且术中创伤较小,患者术后恢复较快,预后理想。
Objective To explore the clinical effect of different surgical methods on Chiari Ⅰ malformation with syringomyelia and atlantoaxial dislocation.Methods The clinical and follow-up data of 80 patients with Chiari I malformation combined with syringomyelia and atlantoaxial dislocation who were treated in neurosurgery of our hospital from 2019 to May 2021 were retrospectively analyzed.According to the different surgical schemes,patients who received posterior fossa decompression+atlantoaxial reduction and internal fixation were included in the conventional group,and patients who received modified atlanto-occipital decompression+occipital-cervical internal fixation were included in the modified group.The operation index,spinal cord index,Chicago Chiari Outcome Scale(CCOS)score and adverse events were compared between the two groups.Results The amount of intraoperative bleeding,operation time and postoperative hospital stay in the modified group were less than those in the conventional group(t=8.725,10.815,6.064,P<0.05);the VD-max,VU-max,ADI and the diameter of syringomyelia in the modified group were all smaller than those before the operation(t=16.889,29.478,17.689,16.841,P<0.05),and the VD-max,VU-max,ADI and the diameter of syringomyelia in the conventional group were also smaller than those before the operation(t=17.661,28.954,17.314,16.547,P<0.05);there was no difference between the two groups before and 6 months after operation(P>0.05).The score of CCOS in the modified group and the conventional group at 6 months after operation was significantly higher than that before operation(t=55.520,138.323,P<0.05);However,there was no difference in the score of CCOS between the two groups before and 6 months after operation(P>0.05);the incidence of adverse events in the improved group was 3.2%lower than that in the conventional group(20.4%,χ^(2)=4.727,P<0.05).Conclusion Modified atlantooccipital decompression combined with occipito-cervical internal fixation can effectively improve the spinal cord indexes of patients with Chiari I malformation combined with syringomyelia and atlantoaxial dislocation,and the trauma during operation is small,the patients recover quickly after operation,and the prognosis is ideal.
作者
郭辉
GUO Hui(Neurosurgery Department,Gongyi People's Hospital,Zhengzhou 451200,Henan Province,China)
出处
《罕少疾病杂志》
2024年第10期113-115,共3页
Journal of Rare and Uncommon Diseases
关键词
ChiariⅠ畸形
脊髓空洞症
寰枢椎脱位
改良寰枕减压术
枕颈内固定术
Chiari Ⅰ Malformation
Syringomyelia
Atlantoaxial Dislocation
Modified Atlanto-occipital Decompression
Occipitocervical Internal Fixation
