齿状突磨除联合钛板枕骨-颈椎后固定术在Chiari畸形Ⅰ型患者颅脊角改善中的临床应用

Combination of Odontoid Removal and Titanium Plate OccipitalCervical Posterior Fixation Suture for Patients with Type I Chiari Malformation

目的：分析齿状突磨除联合钛板枕骨-颈椎后固定术在Chiari畸形Ⅰ型患者颅脊角改善中的临床价值。方法选取1994年9月~2004年9月于本院就诊的Chiari畸形Ⅰ型患者36例，随机分为对照组（21例）和试验组（15例）。对所有患者进行颅脊角测量后，对对照组患者行枕下后颅窝减压术联合硬脑膜扩大修补术，对试验组患者行齿状突磨除联合钛板枕骨-颈椎后固定术。结果与对照组比较，试验组的颅脊角更小，枕骨大孔径、斜坡的长度和Twings线长度更长，两组差异均有统计学意义。试验组的临床总有效率显著高于对照组，并发症发生率显著低于对照组，两组差异均有统计学意义。试验组随访的远期效果显著优于对照组，差异有统计学意义。结论采用齿状突磨除联合钛板枕骨-颈椎后固定术对Chiari畸形Ⅰ型患者进行治疗，具有良好的效果。

Objective To study the clinical effectiveness of combination of odontoid removal and titanium plate occipital-cervical posterior fixation suture in cranial spinal angle improvement for patients with type I Chiari malformation. Methods Altogether 36 patients who had been diagnosed with type I Chiari malformation from September 1994 to September 2004 were divided randomly into control group （n=21） and experiment group （n=15）. Cranial ridge angle measurement was made in patients of both groups. Additionally, all the patients in control group received the combination of suboccipital-posterior cranial fossa ecompression and endocranium expansion-repairing. While, the patients in experiment group received the combination of odontoid removal and titanium plate occipital-cervical posterior fixation suture.Results The cranial spina angle was smaller and the foramen magnum diameter, slope and twings length were significantly longer in experiment group than that in control group with statistically significant differences. The total clinical efficacy rate in experiment group was significantly higher with lower occurrence rate of complications and statistically significant differences. The follow-up long-term effectiveness in experimental group was significantly lower than that in control group with statistically significant differences. Conclusion Application of combination of odontoid removal and titanium plate occipital-cervical posterior fixation suture in treatment of patients with type I Chiari malformation achieved excellent therapeutic effectiveness.