合并无症状性Chiari-Ⅰ型畸形脊柱侧凸的手术治疗

Surgical treatment for asymptomatic Chiari-Ⅰ scoliosis

目的探讨伴有无症状Chiari-Ⅰ型畸形的脊柱侧凸手术矫正的策略和方法。方法伴发脊柱侧凸的无自觉症状的Chiari-Ⅰ型畸形患者18例,男10例,女8例,平均年龄14.5岁。进行侧凸矫形,单纯后路矫形植骨融合固定10例,前路松解后路截骨固定矫形3例,前路松解固定和后路截骨固定3例,后路生长棒固定矫形2例。固定器械均采用中华长城内固定系列。其中17例患者行枕大孔扩大减压成形手术治疗后再行矫形手术。结果术前冠状面的Cobb角平均70.4°,术后Cobb角平均20.8°,术前矢状面后凸的平均46°,术后平均15.8°,术前平均身高148.9cm,术后平均身高154.8cm,平均增高5.9cm,平均随访24个月,侧凸和后凸矫正平均丢失分别为5%和4%,未发现假关节形成,17例对治疗结果表示满意。结论对于合并有Chiari-Ⅰ脊柱侧凸,针对不同年龄和侧凸弯曲和柔韧性,以及小脑扁桃体下移的程度,先行枕骨大孔扩大硬膜切开成形,再行侧凸矫形,可以取得安全满意的矫形效果。

Objective To investigate the surgical strategy for asymptomatic Chiari-Ⅰ scoliosis, and to evaluate the follow-up of the outcomes. Methods Eighteen patients with the mean age of 14. 5 were included in this study. They were 10 males and 8 females. All patients sustained asymptomatic Chiari-Ⅰ scoliosis. Ten underwent correction with a posterior approach and bone grafting with fusion. Three underwent anterior release and posterior osteotomy fixation. Three underwent anterior release fixation and posterior osteotomy fixation. Two underwent posterior growth rod fixation. Results The average pre-operative coronal Cobb angle was 70.4°, while the post-operative one was 20.8°. The average pre-operative sagittal Cobb angle was 46°, while the post-operative one was 15.8°. The average body height was 148.9cm pre-operatively and 154.8cm post-operatively. The mean height gain was 5.9cm. After 24 months of follow-up, the loss of correction of scoliosis and kyphosis was 5% and 4% respectively. No pseudarthrosis was found. Conclusions For patients with asymptomatic Chiari-Ⅰ scoliosis, judging from the age, the curvature and the flexibility, and the downshift of tonsilla cerebelli, the foramen magnum enlargement and epidural incision is performed first, then the correction of scoliosis was performed to achieve safe results.