后颅窝减压术治疗Chiari畸形I型对颅-颈交界区稳定性的影响

Effect of posterior fossa decompression on craniovertebral junction stability in the treatment of Chiari type I malformation

目的探讨后颅窝减压术治疗Chiari畸形Ⅰ型(CM-Ⅰ)对颅-颈交界区(CVJ)稳定性的影响,分析CM-Ⅰ的最佳治疗方法。方法回顾性分析南昌大学第二附属医院神经外科自2015年1月至2020年1月接受后颅窝减压术+枕大池扩大成形术治疗的CM-Ⅰ患者的临床资料,根据CVJ失稳影像诊断参数将患者分为稳定组和失稳组,根据脊髓空洞、改良日本骨科协会及芝加哥Chiari畸形预后量表评分评估手术疗效,并分析失稳的影响因素。结果纳入89例患者作为研究对象,随访3~55个月,有4例患者术前无失稳但在术后3~4年出现寰枕关节失稳纳入失稳组,稳定组85例,2组患者临床症状和体征得到明显改善。结论后颅窝减压术治疗CM-Ⅰ安全有效,并且对CVJ稳定性无明显影响,是CM-Ⅰ的首选治疗方式。

Objective To investigate the effect of posterior fossus decompression for Chiari malformation typeⅠ(CM-Ⅰ)on the stability of craniocervical junction,to analyze the best treatment method of CM-Ⅰ.Methods The CM-Ⅰpatients who received cranial fossus decompression+enlarged cisternplasty in in the Neurosurgery Department of the Second Affiliated Hospital of Nanchang University from January 2015 to January 2020 were retrospectively collected.According to the imaging diagnostic parameters of craniocervical junction instability,the patients were divided into the stability group and the instability group.The surgical efficacy was evaluated and the influencing factors of instability were analyzed according to the myelomyelia volume,modified Japanese Orthopedic Association and the Chicago Chiari outcome scale.Results Of the 89 subjects who were followed up for 3 to 55 months,4 had no craniocervical junction instability before surgery and had atlanto-occipitocervical joint instability 3 to 4 years after surgery,85 in the stability group.The clinical symptoms and function of patients in both groups were significantly improved.Conclusion Posterior fossa decompression is safe and effective,and has no significant effect on the stability of craniocervical junction.Therefore,it is the preferred treatment for CM-Ⅰ.