一种术前评分标准在ChiariⅠ畸形手术方式选择中的应用价值

Application Value of a Preoperative Scoring Standard in the Selection of ChiariⅠMalformation Surgery

目的探讨ChiariⅠ畸形术前评分对手术方式的选择及预后的应用价值。方法回顾性分析2015年7月~2019年7月我院收治的ChiariⅠ畸形患者60例的临床资料,分别采用单纯骨性减压术(PFD)、硬脑膜扩大成形术(PFDD)、小脑扁桃体切除术治疗,按照本科室制定的术前评分标准(总分12分)将患者分为低分组(<6分)及高分组(>6分),分析患者预后情况,比较两组不同手术方式下的Chicago-Chiari预后量表(CCOS)评分及术前评分。结果①60例患者术后缓解45例(75.00%),随访显示预后良好49例,不同手术方式的患者总体预后比较,差异无统计学意义(P>0.05);低分组中,三种手术方式患者的CCOS评分比较,差异无统计学意义(P>0.05);高分组中,行小脑扁桃体切除术者CCOS评分优于行PFDD者[(8.35±1.15)分vs(7.5±0.97)分],差异有统计学差异(P<0.05)。结论术前评分标准对ChiariⅠ畸形手术方式的选择有一定参考价值。对于评分小于6分,可选择行单纯骨性减压术或硬脑膜扩大成形术;对于评分大于6分者,显微镜下行小脑扁桃体切除术的预后可能更好。

Objective To explore the value of ChiariⅠmalformation preoperative scoring in the selection of surgical methods and prognosis.Methods A retrospective analysis of the clinical data of 60 patients with ChiariⅠmalformation admitted to our hospital from July 2015 to July 2019 were performed using simple bone decompression(PFD),expanded dural angioplasty(PFDD),cerebellar tonsillectomy treatment,according to the preoperative scoring standard(total score 12)formulated by the undergraduate,the patients were divided into low group(<6 points)and high group(>6 points),and the prognosis of patients was analyzed.The Chicago-Chiari Outcome Scale(CCOS)score and preoperative score were compared between the two groups under different surgical methods.Results①45 cases(75.00%)of 60 patients were relieved postoperatively.Follow-up showed good prognosis in 49 cases.There was no significant difference in overall prognosis of patients with different surgical methods(P>0.05);In the low group,there was no statistically significant difference in the CCOS scores of the three surgical methods(P>0.05);In the high group,the CCOS score of those who underwent cerebellar tonsillectomy was better than those who underwent PFDD[(8.35±1.15)points vs(7.5±0.97)points],the difference was statistically significant(P<0.05).Conclusion The preoperative scoring standard has certain reference value for the choice of ChiariⅠmalformation surgery.For scores less than 6 points,simple bone decompression or dural enlargement can be selected;for scores greater than 6,the prognosis of cerebellar tonsillectomy under microscope may be better.