脊柱侧凸伴发Chiari畸形/脊髓空洞的治疗策略

Treatment strategy of scoliosis associated with Chiari malformation/syringomyelia

目的探讨伴发Chiari畸形/脊髓空洞的脊柱侧凸手术治疗的新思路,并分析手术疗效。方法将18例伴发Chiari畸形/脊髓空洞的脊柱侧凸患者根据治疗方案分三组:A组(6例)牵引后行前后路联合或后路脊柱侧凸矫形手术,B组(6例)行颈枕部手术加脊柱侧凸矫形术,C组(6例)直接行后路脊柱侧凸矫形手术。结果A组Cobb角平均矫正率为61%,B组Cobb角平均矫正率为60%,C组Cobb角平均矫正率为52%。结论对脊柱侧凸较为柔软、伴无明显神经损害的Chiari畸形/脊髓空洞患者,在术前仰卧侧屈位X线片Cobb角范围内直接行后路矫形术,矫形效果良好、安全,手术并发症少,患者痛苦及经济负担均小。

[Objective] To evaluate the new treatment strategy to the scoliosis with Chiari malformation and/ or syringomyelia,and analyze the effect of operation. [Methods] 18 cases suffered from scoliosis with Chiari malformation and/or syringomyelia were divided into 3 groups according to surgical treatment：Group A 6 cases were performed anterior combined with posterior operation after Halo＇s traction of one week. Group B 6 cases underwent posterior suboccipital craniectomy to enlarge foramen occipital magnum,then underwent C1 posterior arch decompression,duraplasty and syrinx-subarachnoid space shunting,and their scoliosis was corrected after six months ; Group C 6 cases were directly performed posterior orthopedic operation. [Results] In Group A, the average frontal correction was 61%. In Group B,the average frontal correction was 60 %. In Group C,the average frontal correction was 52%. [Conclusion] Patients having soft scoliosis with Chiari malformation and/or syringomyelia without obvious neurological impairment can be only post-operated on the basis of lateral-bending radiograph, not only the therapeutic effect was fine, but also complications and expenditures of operation was fewer.