枕大孔区减压环枕筋膜松解术治疗CMⅠ-SM的疗效分析

Foramen Magnum Decompression Ring Pillow Fascia Lysis for Chiari Malformation Type Ⅰ Combined with Syringomyelia

目的:回顾分析枕大孔区减压环枕筋膜松解术治疗Chiari畸形Ⅰ型合并脊髓空洞症(CMⅠ-SM)的疗效及其适应症。方法:随访71例行枕大孔区减压环枕筋膜松解术治疗的CMⅠ-SM患者,回顾手术疗效,利用多因素Logistic回归分析探讨病程时间(A)、是否伴有后颅窝畸形(B)、是否有增厚的环枕筋膜(C)及减压后脑脊液搏动情况(D)与疗效的关系,继而推断枕大孔区减压环枕筋膜松解术的适应症。结果:本组患者症状改善49例,占73.1%;稳定15例,占22.4%;恶化3例,占4.5%。A、B与疗效不具有统计学意义;C、D与疗效具有统计学意义。结论:枕大孔区减压环枕筋膜松解术是治疗CMⅠ-SM较为合理的术式;术中观察有增厚的环枕筋膜和(或)减压后脑脊液搏动改善良好可作为选择该术式的适应症。

Objective： To evaluate the appropriate surgical procedure for Chiari I malformationcomplicated by syringomyelia （CM Ⅰ -SM ）. Methods： A total of 71 patients after foramen magnum decompression （FMD） combined with removal of dural band were retrospectively the efficacy of surgical procedure. Use the multiple factor Logistic regression analysis to evaluate the relationship between the efficacy of surgical procedure and the course of disease, accompany posterior cranial fossa malformation or not, accompany the incrassated dural band or not and the pulsation of cerebrospinal fluid after FMD. Results： 49 patients were improved after operation by follow-up, 15 patients were stabilized, and 3 patients were aggravated, with the rate of 73.1%, 22.4% and 4.5% respectively. Conclusion： FMD combined with removal of dural band is a reasonable option for the treatment of CM Ⅰ -SM. For the choice of the different operation, it is necessary to make a detailed assessment of its accompany the incrassated dural band or not and the pulsation of cerebrospinal fluid after foramen magnum decompression.