探讨改良颅窝减压术在Chiari畸形Ⅰ型患者中的应用及对脑脊液动力学的影响

Explore the application of modified cranial fossa decompression in patients with Chiari malformation typeⅠand its effect on cerebrospinal fluid dynamics

目的探讨改良颅窝减压术在Chiari畸形Ⅰ型患者中的应用及其对脑脊液动力学的影响。方法选取2018年4月至2020年4月山西省晋城市人民医院神经外科收治的110例Chiari畸形Ⅰ型患者,男57例,女53例,年龄(38.21±4.11)岁,年龄范围为20~60岁。按照手术方法不同分为实施传统颅窝减压术的传统组(n=61)与实施改良颅窝减压术的改良组(n=49),比较两组患者随访1年的治疗效果、影像学改善情况、手术前后脑脊液动力学指标[头端最大峰值流速(VDmax)、尾端最大峰值流速(VUmax)、每搏输出量(SV)]、并发症发生率。结果改良组疾病控制率[93.9%(46/49)]高于传统组[80.3%(49/61)],差异有统计学意义(P<0.05)。改良组与传统组患者影像学改善情况比较,差异无统计学意义(P>0.05)。术后改良组VDmax[(5.67±1.27)cm/s]、VUmax[(3.25±1.17)cm/s]低于传统组[(6.89±1.65)cm/s、(4.39±1.25)cm/s],SV[(0.04±0.01)ml]高于传统组[(0.03±0.01)ml],差异有统计学意义(P<0.001)。改良组并发症发生率[4.1%(2/49)]低于传统组[14.8%(9/61)],差异有统计学意义(χ^(2)=4.238,P=0.040)。结论改良颅窝减压术治疗Chiari畸形Ⅰ型患者的效果显著,可有效缓解临床症状,影像学更好,同时还可促进改善脑脊液动力学指标,也降低了并发症发生风险,安全性更高。

Objective To explore the application of modified cranial fossa decompression in patients with Chiari malformation typeⅠand its effect on cerebrospinal fluid dynamics.Methods Select 110 patients with Chiari malformation typeⅠadmitted to the department of Neurosurgery,Jincheng People′s Hospital in Shanxi Province from April 2018 to April 2020.There were 57 males and 53 females,aged(38.21±4.11)years old,ranging from 20 to 60 years old.According to the different surgical methods,they were divided into the traditional group(n=61)and the modified group(n=49)with traditional cranial fossa decompression,and the treatment effects and images of the two groups were compared for a 1-year follow-up.Academic improvement,cerebrospinal fluid dynamics indicators before and after surgery[maximum peak flow velocity at the tip(VDmax),maximum peak flow velocity at the tail(VUmax),stroke volume(SV)],and complication rate.Results The disease control rate of the modified group[93.9%(46/49)]was higher than that of the traditional group[80.3%(49/61)],and the difference was statistically significant(P<0.05).There was no significant difference in imaging improvement between the improved group and the traditional group(P>0.05).VDmax[(5.67±1.27)cm/s]and VUmax[(3.25±1.17)cm/s]of the modified group after operation were lower than the traditional group[(6.89±1.65)cm/s,(4.39±1.25)cm/s],SV[(0.04±0.01)ml]was higher than the traditional group[(0.03±0.01)ml],the difference was statistically significant(P<0.001).The complication rate of the modified group[4.1%(2/49)]was lower than that of the traditional group[14.8%(9/61)],and the difference was statistically significant(χ^(2)=4.238,P=0.040).Conclusion Modified cranial fossa decompression surgery is effective in treating Chiari malformation typeⅠpatients,which can effectively alleviate clinical symptoms,improve the imaging,and promote the improvement of cerebrospinal fluid dynamics,reduce the risk of complications and improve the safety.