枕骨大孔减压伴硬膜外层切开术治疗Chiari畸形合并脊髓空洞症的临床研究

Clinical Study of Foramen Magnum Decompression with Removal of the Outer Layer of the Dura for Chiari Malformation Associated with Syringomyelia

目的探讨枕骨大孔减压伴硬膜外层切开术治疗Chiari畸形合并脊髓空洞症(ACM-SM)的手术疗效。方法按患者手术方式不同分为两组:A组30例,枕骨大孔减压组;B组38例,枕骨大孔减压伴硬膜外层切开组,回顾性分析两组患者预后情况。结果近期疗效:出院时,A组有效率70%(21/30),B组有效率92.1%(35/38),二者比较,B组患者近期疗效优于A组(P=0.02);远期疗效:A组67.9%(19/28)的患者症状有不同程度改善;B组93.9%(31/33)的患者症状有不同程度改善,两者比较,B组患者远期临床症状改善率优于A组(P<0.05);脊髓空洞:A组20例患者脊髓空洞大小较术前有不同程度缩小,6例空洞较前无明显变化,2例空洞较前略增大;B组患者随访提示31例患者脊髓空洞大小较术前有不同程度缩小,2例空洞较前无明显变化,无空洞增大病例,两者比较,B组患者在脊髓空洞改善方面优于A组(P<0.05)。结论外科手术是治疗ACM-SM的有效方法,应根据患者具体情况选择不同的术式;枕骨大孔减压伴硬膜外层切开术治疗ACM-SM患者术后长短期疗效均优于枕骨大孔减压术。

Abstract： Objective To investigate the outcomes of foramen magnum decompression with removal of the outer layer of the dura on Chiari malformation with syringomyelia （ACM-SM） compared with foramen mag- num decompression. Methods Thirty patients were performed （ Group A） foramen magnum decompression and thirty-eight patients were performed foramen magnum decompression with removal of the outer layer of the dura（ Group B）. In the end, the outcomes were documented and analyzed. Results Short-term effects： at the time of discharge, in group A, 21 （70%） patients achieved an improvement in their clinical symptoms. In Group B, 35（92.1% ） patients achieved an improvement in their clinical symptoms. The outcomes of group B was better than that of group A （P = 0.02）. Long-term effects ：28 patients were followed up in group A, among which 19 （67.9%） patients had an improvement in their clinical symptoms. 33 patients were followed in group B, among which 31 （93.9%）patients had an improvement in their clinical symptoms. The outcomes of group B was better than that of group A （P 〈0.05）. MRI showed that in group A, syringomyelia decreased in 20 cases. In group B, syringomyelia decreased in 31 cases. By chi-square test（ x2 test）, the syringomyelia got more narrow in group B than that of group A （P 〈 0.05 ）. Conclusions Operation is an effective treatment for A CM-SM. Different methods should be chosen according to the patients＇unique feature. Foramen magnum decompression with removal of the outer layer of the dura is better than foramen magnum decompression in either long-term effects or short-term effects.