保留寰椎后弓对Ⅰ型Chiari畸形手术效果的影响

Effect of preservation of posterior arch of atlas integrity on the operation of Chiari malformation typeⅠ

目的研究保留寰椎后弓对小脑扁桃体下疝手术临床疗效的影响。方法回顾性分析2017-01—2019-05徐州医科大学附属医院收治的63例Ⅰ型Chiari畸形患者,其中35例行保留寰椎后弓的小脑扁桃体下疝手术,28例行寰椎后弓切除的小脑扁桃体下疝手术,比较寰椎后弓保留组和切除组患者手术时间、术中出血量、术后住院时间、术后并发症、术后12个月颈椎主动活动度等指标。术后随访1 a,使用KPS和CCOS评分评价两种术式对患者预后的影响。结果2组住院时间、术中出血量、术后并发症、术后KPS和CCOS评分等方面差异无统计学意义(P>0.05),而寰椎后弓保留组手术时间明显缩短,差异有统计学意义(P<0.05);寰椎后弓切除组颈椎左右旋转角度较保留组明显减小,差异有统计学意义(P<0.01)。结论保留寰椎后弓的小脑扁桃体下疝手术是一种安全有效的术式,保留寰椎后弓不仅缩短了手术时间,而且有效防止术后颈椎活动度的减小。

Objective To explore the effect of preservation of posterior arch of atlas integrity on the operation of Chiari malformation typeⅠ.Methods The clinical data of 63 patients with Chiari malformation typeⅠtreated in the Affiliated Hospital of Xuzhou Medical University from January 2017 to May 2019 were analyzed retrospectively.According to the different surgical approaches,the patients were divided into the preservation of posterior arch of atlas group(n=35)and the removal of posterior arch of atlas group(n=28).The hemorrhages quantities,the operation time,postoperative hospital-ization,postoperative complications and cervical mobility 12 months after surgical operation were compared between the two groups.One year follow-up,KPS and CCOS were used to evaluate the effect of the two operations on the prognosis of patients.Results There was no significant difference in postoperative hospital-ization,the operation time,postoperative complications,KPS and CCOS score between the two groups(P>0.05).The operation time of posterior arch retention group was significantly shorter(P<0.05).The left and right rotation angles of cervical vertebrae in patients with posterior arch removal were significantly smaller than those in the retention group(P<0.05).Conclusion The operation of Chiari malformation typeⅠwith posterior arch retention is a safe and effective approaches.The retention of the posterior arch not only shortens the operation time,but also effectively prevents the reduction of cervical vertebra mobility.