后颅窝骨性扩大术治疗Chiari畸形合并脊髓空洞症

Surgical Treatment of Chiari Malformation with Syringomyelia:Enlarged Posterior Fossa Osteoplasty

目的 介绍后颅窝骨性扩大术治疗Chiari畸形合并脊髓空洞症。方法 该手术分为两种亚术式 ,一种是枕颈固定扩大术 :取自体髂骨 5cm× 10cm ,打磨成“凹”字形。上端为齐头端 ,固定在后颅窝减压窗缘。缺口端为下端 ,固定在枢椎棘突上 ,将扩大的硬脑 (脊 )膜修补筋膜片固定在植骨片内面 ,使筋膜片贴附在植骨片内面 ,形成帐篷状 ;另一种是单纯骨性扩大术 :取自体髂骨 6cm× 8cm的梯形骨片 ,并利用较厚的髂骨缘打磨成弧形。植骨片固定在后颅窝减压窗上 ,弧形端构成枕骨大孔后缘。将扩大的硬脑 (脊 )膜修补筋膜片也固定在植骨片内面 ,使筋膜片贴附在植骨片内面 ,也形成帐篷状。结果 本组病例随访 2～ 7年 ,术后症状体征缓解总有效率为91.6% ,肌力比以前提高 2～ 3级。结论 该术式比其他治疗Chiari畸形合并脊髓空洞症的术式 ,治疗效果显著 。

ObjectiveTo introduce posterior fossa o steoplasty to cure Chiari malformation with syringomyelia. MethodsThe operations were divided into two kinds. One kind of operation was occipital-axoid fixation: autologous bone implant gained from ilium carved in 5 cm×10 cm size and 'V' shape. One section was fixed on the superior side of occipital bone of depression. The other section was fixed on the spinous process of axis. The dura implant was sutured inside bone implant and turned into tent-shape. The other kind of operation was osteo-expension: autologous bone implant gained from ilium with size 6 cm×8 cm with ladder shape. Crista iliaca of bone implant carved into arch shape was fixed on the occipital decompression. The section in arch shape of bone implant formed posterior margin of foramem magnum. The dura implant was sutured inside the bone implant and maded into the tent-shape. ResultsThe patients were followed up for 2-7 years. The rate of recovery or stability of clinical demonstration in this group was 91.6% . ConclusionThe operation is more effective and reliable than any other operation to treat Chiari malformation with syringomyelia.