应用上颈椎内固定技术治疗Chiari Ⅰ畸形的可行性探讨

Upper cervical internal fixation techniques for the treatment of Chiari I malformation: discussion on the feasibility

目的探讨运用上颈椎内固定技术治疗ChiariⅠ畸形伴脊髓空洞的可行性。方法将2006年12月至2012年12月在我科接受手术治疗并符合入选标准的186例ChiariⅠ畸形伴脊髓空洞患者分为内固定组和非内固定组。所有患者均于术前进行日本骨科协会(JOA)评分及脊髓空洞测量,并于术后1 w、3个月、6个月及12个月进行随访,对其原有症状的改善程度及脊髓空洞的缩小程度进行完备记录。所得数据采用重复测量资料的方差分析对患者的JOA评分、脊髓空洞大小等指标进行分析。结果术后6个月、12个月内固定组JOA评分均高于非内固定组,其差别有统计学意义(P<0.05);术后6个月、12个月内固定组脊髓空洞均小于非内固定组,其差别有统计学意义(P<0.05)。结论运用上颈椎内固定技术治疗ChiariⅠ畸形伴脊髓空洞,能有效重建上颈椎稳定性,对改善患者术后中远期症状、缩小脊髓空洞起到重要作用。手术操作简单安全,并发症少,值得临床进一步推广。

Objective The diagnosis and treatment of Chiari I malformation associated with syringomyelia with upper cervical internal fixation technology are discussed. Methods From December 2006 to December 2012, a total of 186 patients with Chiari malformation associated with syringomyelia I undergoing surgery were enrolled in the study and all the patients were divided into internal fixation and non- fixation groups. All the patients were evaluated by the Japanese orthopaedic association （JOA） score and underwent the syringomyelia measurement before operation, and were followed up at 1 week, 3 months, 6 months and 12 months after operation. The symptoms and the spinal cord narrowing improvement were all recorded and the JOA score and the empty size of the spinal cord were analyzed by variance analysis. Results After 6 months, JOA scores of fixation group at 12 months were higher than that of the internal fixation group with significant statistical difference （P 〈 0.05 ） ; while empty size of spinal cord at 12 months in fixation group were smaller than that of the internal fixation group with significant statistical difference （ P 〈 0.05 ）. Conclusion Application of upper cervical internal fixation for the treatment of Chiari I malformation associated with syringomyelia can reconstruct the cervical stability, improve the post-operative symptoms of patients for a long term, and alleviate the syringomyelia. Operation is simple and safe with less complication, so it is worth of popularizing in clinical practices.