手术治疗ChiariⅠ型畸形的效果分析

Efficacy ofsurgical therapy in management of Chiari Ⅰ malformation

目的比较单纯后颅窝减压术和后颅窝减压+硬膜成形+小脑扁桃体切除术治疗ChiariⅠ型畸形的临床效果。方法选择我科2008-08—2015-09收治的67例ChiariⅠ型畸形患者进行回顾性分析,其中行单纯后颅窝减压术治疗组27例,后颅窝减压+硬膜成形+小脑扁桃体切除术治疗组40例。结果术后随访12~48个月,单纯后颅窝减压组和后颅窝减压+硬膜成形+小脑扁桃体切除组在头痛及颈肩部不适的改善率分别为81.25%、76.00%(P>0.05);肢体感觉障碍的好转率分别为33.33%、65.71%,差异有统计学意义(P<0.05);脊髓空洞缩小率分别为33.33%、67.86%,差异有统计学意义(P<0.05)。2组并发症发生率比较无显著差异(P>0.05)。结论后颅窝减压+硬膜成形+小脑扁桃体切除组总体效果较显著,但在缓解头痛及颈肩部不适方面与单纯后颅窝减压术无明显差异,应根据临床特点选择个体化治疗方案。

Objective To compare the efficacy of posterior cranial fossa decompression alone and posterior cranial fossa decompression ＋ dural enlargement repair＋ resection of the cerebellar tonsils in the treatment of Chiari I malformation. Methods We retrospectively analyze Chiari I malformation patients treated in our neurosurgery department between August 2008 and Sept 2015,27 patients received pure posterior cranial fossa decompression, and 40 patients received posterior fossa decompression＋ dural enlargement repair＋resection of the cerebellar tonsils. Results All the cases were followed up for 12-48 months. The improvement rate of headache and discomfort of neck and shoulder were 81.25 %, 76.00 % （P 〉 0.05）, respectively in two groups. The extremity sensory disturbance was improved in 33.33 % and 65.71%, respectively in two groups（P 〈0.05）. The syringomyelia was decreased in 33.33% and 67.86% ,respectively in two groups（P〈0.05）. The complication rate had no significant difference in two groups（P〉0.05）. Conclusion The overall effect of posterior fossa decompression＋dural enlargement repair＋resection of the cerebellar tonsils is remarkable,but there is no significant difference on alleviating headache and discomfort of neck and shoulder in two groups. We should choose individualized treatment according to the clinical characteristics.