改良后颅窝减压术治疗Chiari畸形Ⅰ型的疗效观察

Curative effect of modified posterior fossa decompression surgery in treatment of Chiari type Ⅰ malformation

目的:探讨改良后颅窝减压术治疗Chiari畸形Ⅰ型的临床疗效和预后。方法:回顾性分析98例Chiari畸形Ⅰ型患者的临床资料,将48例改良手术治疗组(枕骨大孔区减压,硬膜外层松解)与50例对照组(传统术式治疗组,即后颅窝减压,硬脑膜成形,蛛网膜粘连松解,小脑扁桃体下疝切除)对比,观察评估患者术后短期和远期临床表现、并发症及影像学改善情况。结果:术后短期随访,两组临床表现改善情况差异无统计学意义(P>0.05),改良组脑脊液漏等并发症少于对照组(P<0.05);术后远期随访,两组临床表现改善情况差异有统计学意义(P<0.05),改良组临床表现改善情况为73.2%,对照组51.1%;影像学改善情况差异无统计学意义(P>0.05)。结论:改良后颅窝减压术治疗Chiari畸形Ⅰ型是有效的,临床表现改善较为明显,且脑脊液漏等并发症较少。

Objective： To investigate the effect and prognosis of modified surgical treatment of type I Chiari malformation. Methods： A retrospective study was to compare the improvement group, 48 patients （the decompression of the foramen magnum, release of epidural） and the control group, 50 patients （the traditional surgery, the decompression of posterior cranial fossa, dura plastic repair, release of spider adhesion, resection of cerebellar herniation） in the neurosurgery department. The short-term and long-term improvement of the clinical manifestation, complications and imaging after operations were observed and evaluated. Results： There was no statistical significance between the two groups in the improvement of clinical manifestations in the short term follow-up （P〉0.05）, and the number of complications on cerebrospinal fluid leakages in the modified group was lower than the control （P〈0.05）. The rate of clinical improvement in the improvement group was 73.2% and 51.1% in the control group in the long term follow-up （P〈0.05）, indicating significant difterences in the elinical improvement. The differences of two groups in the radiologic improvement were not statistically significant （P〉0.05）. Conclusion： The modified posterior fossa decompression surgery in treatment of Chiari type I malformation is efficient, which remarkably may improve the clinical manifestation with less complications.