微创手术治疗Chiari畸形Ⅰ型并脊柱侧凸的疗效观察

Observation of the curative effect of minimally invasive surgery in the treatment of Chiari malformation type Ⅰ combined with scoliosis

目的探讨微创软脑膜下小脑扁桃体下疝切除、枕大池重建术治疗Chiari畸形Ⅰ型(CM-Ⅰ)并脊柱侧凸畸形的临床效果。方法通过对2015年1月至2017年12月在郑州大学附属郑州中心医院脊髓空洞症专科16例接受微创手术治疗的CM-Ⅰ并脊柱侧凸畸形患者进行回顾性研究,将研究对象分为儿童组(8例)和青少年组(8例),脊柱侧弯测量角Cobb角<35°组(6例)和Cobb角≥35°组(10例)进行比较分析。结果微创手术治疗后,平均随访2年。在儿童组和青少年组中,微创术后脊柱侧凸改善6例(37.5%),恶化5例(31.3%),无变化5例(31.3%)。其中儿童组有3例(37.5%)需要行脊柱侧凸矫正手术,青少年组有6例(75.0%)需要行脊柱侧凸矫正手术。Cobb角<35°组和Cobb角≥35°组中,术前Cobb角≥35°组的患者(7/10例,70.00%)比Cobb<35°组的患者(2/6例,33.33%)更需要进行脊柱侧凸矫正手术(P=0.018)。结论CM-Ⅰ并脊柱侧凸患者Cobb角<35°时行微创软脑膜下小脑扁桃体下疝切除、枕大池重建术干预可能能改善或稳定脊柱侧凸。

Objective To explore the clinical effect of minimally invasive subpial resection of the cerebellar tonsillar and the reconstruction of the cisternoma in the treatment of Chiari malformation typeⅠ(CM-Ⅰ)combined with scoliosis.Methods A retrospective study was carried out for 16 CM-Ⅰscoliosis patients who underwent minimally invasive surgery.The subjects were divided into children group(8 cases)and adolescents group(8 cases),with Cobb angle<35°group(6 cases)and Cobb angle≥35°group(10 cases).Results After minimally invasive surgery,the average follow-up was 2 years.In the children and adolescent groups,6 cases(37.5%)of scoliosis improved after accepting minimally invasive surgery,5 cases(31.3%)worsened,and none changed in 5 cases(31.3%).Among them,3 cases(37.5%)in the children group required scoliosis correction surgery,and 6 cases(75.0%)in the adolescents group needed scoliosis correction surgery.In the Cobb angle<35°group and the Cobb angle≥35°group,patients in the preoperative Cobb angle≥35°group(7/10 cases,70.00%)required more treatment than those in the Cobb angle<35°group(2/6 cases,33.33%)scoliosis correction surgery(P=0.018).Conclusions In CM-Ⅰpatients combined with scoliosis,when the Cobb angle is less than 35°,minimally invasive subpial resection of the cerebellar tonsillar and reconstruction of the cisternoma may improve or stabilize the scoliosis.