硬膜补片与自体筋膜成形修补术治疗Chiari畸形合并脊髓空洞症的对照研究(英文)

Duraplasty with Neuropatch versus autologous fascia lata for Chiari I malformation with syringomyelia: A comparative study

目的评价硬膜补片(Neuropatch,商品注册号国药管字第2002-346032)治疗Chiari畸形合并脊髓空洞的疗效及术后反应。方法2002年6月至2004年6月收治Chiari畸形合并脊髓空洞患者40例,所有患者均行枕大孔减压及硬膜成形术,其中20例应用硬膜补片行硬膜修补(硬膜补片组),余20例患者应用自体阔筋膜修补(自体筋膜组)。观察指标包括两组间手术的时间、术后发热持续的时间、放置引流时间及引流量、术后应用激素及抗生素的时间、依据Tator评分评价术后效果。采用t及χ2进行数据分析。结果硬膜补片组术后有12人(60%)出现发热,自体筋膜组有9人(45%)(χ2=0.902,P=0.342),脑脊液培养均阴性,硬膜补片组与自体筋膜组手术治疗改善均为17例(85%),两组在手术时间、术后发热、引流放置时间及引流量、术后应用抗生素的时间、术后疗效评价差异均无统计学意义,而术后发热持续时间(t=-2.913,P=0.045)及激素应用时间差异有显著性(t=-3.116,P=0.006),随访1～2年自体筋膜组有1例出现迟发伤口炎性肉芽肿,余无迟发感染发生。结论Chiari畸形合并脊髓空洞手术中,硬膜补片(Neuropatch)是一可靠的修补硬膜缺损的硬膜替代物。

Objective： To evaluate the outcome and postoperative reaction of dural substitute （Neuropatch） applying in the treatment of Chiari I malformation（CMI） associated with syringomyelia（SM）. Methods：Forty patients of CMI associated with SM were operated in our department from Jul. 2002 to Jul. 2004. All patients underwent posterior cranial fossa decompression and duraplasty. They were divided into two groups, 20 patients being repaired with Neuropatch （Neuropatch group）, and the others with autologous fascia lata （fascia group）. There were 6 males and 14 females in Neuropatch group and 10 males and 10 females in fascia group. The operations were performed under general anesthesia via suboccipital approach and the extent of posterior cranial fossa decompression ranged from 20 cm2 （5 cm×4 cm） to 35 cm2 （5 cm×7 cm）. The removal of posterior arch of atlas depended on the extent of tonsillar herniation, and the dura was opened in Y shape. The Neuropatch was cut into triangular shape, and the same sized autologous fascia lata was used in fascia group. The patches were sutured tightly to the dura matter in each group. The incision was closed layer by layer and drainage was used, if necessary. Antibiotics and hormone were routinely used. The duration of operation, postoperative fever were evaluated, the outcome of the operation was evaluated by Tator scale, and the data were analyzed with statistic software SPSS 10.0. Results： There were12 patients （60%） who suffered from postoperative fever in the Neuropatch group, and 9 patients （45%） in the fascia group（χ^2=0.902,P=0.342）. Seventeen patients in each group were improved postoperatively. The duration of operation, postoperative fever and antibiotics used were compared between the two groups. No significant difference was found, but the duration of postoperative fever and the time of hormone used were different. There were no postoperative infections that occurred after the follow up for 1 to 2 years, except for one patient in fascia group who developed infective granuloma and recovered later by treatment. Conclusion： Neuropatch is a useful dural substitute for the repair of dural defects in the treatment of CMI associated with syringomyelia.