Chiari畸形合并脊髓空洞症术中不同大小后颅窝减压窗近期疗效的比较

Effect of decompression window area of posterior fossa on short-term surgical outcomes in Chiari malformation patients with syringomyelia

目的探讨不同大小后颅窝骨性减压窗对Chiari畸形合并脊髓空洞症患者手术近期疗效的影响。方法回顾性分析2007。2010年收治的117例Chiari畸形合并脊髓空洞症患者的临床资料，均采用环枕减压硬膜成形术，空洞横径〉脊髓50％者行空洞穿刺减压术。根据后颅窝减压窗面积分为2组：I组，87例，减压面积为12cm。（3cm×4cm）；Ⅱ组，30例，减压面积〈6cm2。术后2周采用Tater评分评定疗效。结果117例患者手术后症状均无加重，症状改善97例（82．9％），无变化20例。I组症状改善76例（87．4％），Ⅱ组为21例（70％）；两组症状改善率差异显著（P〈0．05）。结论Chiari畸形合并脊髓空洞症患者的后颅窝减压面积以不小于12cm。的近期疗效较好。

Objective To explore the effect of decompression skull window area on short-term surgical outcomes in the Chiari malformation （CM） patients with syringomyelia （SM）. Methods The clinical data of 117 patients with CM and SM treated in our hospital from 2007 to 2010 were analyzed retrospectively. The decompression of posterior cranial fossa and duraplasty was performed in all the patients. The decompression of syringomyelias with puncture was performed in the patients in whom the horizontal diameters of the syringomyelias were more than 50% of the horizontal diameters of the spinal cords. The patients were divided into 2 groups according to the decompressed area of the posterior cranial fossa, i.e. group A （n=87） where the decompression skull, window area was about 12 cm2 and group B （n=30） where the skull window area was less than 6 cmk The therapeutic effects were evaluated with Tater scale 2 weeks after the operation in all the patients. Results Of 117 patients, 97 were improved in the postoperative symptoms and 20 not. The rate （87.4%, 76/87） of improved symptoms was significantly higher in group A than that （70.0%, 21/30） in group B （P〈0.05）. Conclusion The decompression skull window area of posterior fossa 1〉 12 cm2 should be recommended in CM patients with SM treated by surgery.