脊柱侧弯并发Chiari畸形的手术治疗

Surgical treatment of scoliosis associated with Chiari malformation

[目的]探讨脊柱侧弯并发Chiari畸形的诊断和治疗方法。[方法]本组12例脊柱侧弯并发Chiari畸形的患者，其中有7例同时伴有脊髓空洞症，所有患者均先由神经外科行枕大孔扩大成形术或空洞分流术，二期行脊柱侧弯后路矫形术。[结果]Cobb＇s角术前平均71°，术后平均24°，矫正率为66％。脊柱矫形术后随访1～4a，平均2．4a，没有发生脱钩、断钉及假关节现象；没有出现新的神经损害表现；感觉障碍及腹壁浅反射减弱的症状没有加重。[结论]对于脊柱侧弯并发Chiari畸形、脊髓空洞症的患者，术前应完善检查、明确诊断；先进行枕大孔扩大成形术或空洞分流术，二期行脊柱侧弯后路矫形术，可以减少脊柱侧弯矫形时引起的神经损害并发症。

[ Objective] To discuss the diagnosis and treatment method of scoliosis associated with Chiari malformation. [ Method] Twelve patients were suffered from scoliosis associated with Chiari malformation, in which there were 7 patients also complicated with syringomyelia. Firstly, posterior suboccipital craniectomy to enlarge foramen occipital magnum was performed, then the patients underwent the scoliosis correction with instrumentation. [ Result] Preoperatively, the mean Cobb＇s angle on the coronal plane was 71°, and 24° postoperatively, with an average correction of 66%. During a follow-up from 1 year to 4 years, there were no release of the hook, no breaking of pedicle screw, no false articulation and no new nervous lesion, while few improving was found about the sensory disability and superficial abdominal hyporeflexia. [ Conclusion ] We should first consummate the examination and make a definite diagnosis for the patients who were suffered from scoliesis associated with Chiari malformation and syringomyelia; posterior suboccipital craniectomy to enlarge foramen occipital magnum or syrinx-subarachnoid space shunting should be performed firstly to reduce nervous lesion during scoliesis correction surgery.