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目的总结采用显微外科技术治疗Chiari畸形Ⅰ型并脊髓空洞的手术技术改进。方法回顾性分析采用显微外科技术治疗Chiari畸形Ⅰ型并脊髓空洞436例的临床资料,10年间对手术步骤进行部分改进,手术方式逐渐由外减压到内减压。采用远期生活质量评估(KPS)和日常生活能力量表评分(ADL)评价疗效,并通过影像学检查对脊髓空洞的变化情况进行评价。结果术后感觉障碍明显改善371例;运动障碍改善312例,加重4例;无死亡病例。术后并发症:后枕部头痛30例,脑神经损伤2例,硬脑膜外囊肿37例,脑脊液漏40例,颅内感染51例,切口脂肪液化45例。170例经头颈部MRI检查显示:脊髓空洞均缩小。随访120例,时间0.5～6.5年,平均2年。末次随访KPS和ADL分值与术前相比,均显著升高(均P<0.01);脊髓空洞缩小及消失率为83.4%。结论颅后窝减压术技术的改进对Chiari畸形Ⅰ型并脊髓空洞的治疗安全、有效。
Objective To summarize the surgical technique of using microsurgical technique to treat type Ⅰ Chiari malformation and syringomyelia. Methods The clinical data of 436 patients with type Ⅰ Chiari malformation and syringomyelia treated with microsurgical technique were retrospectively analyzed. The surgical procedures were partially improved in 10 years, and the surgical procedure was gradually decompressed from external to internal decompression. The long-term quality of life assessment (KPS) and daily living ability scale (ADL) were used to evaluate the curative effect, and the change of syringomyelia was evaluated by imaging examination. Results Postoperative sensory dysfunction improved significantly in 371 cases; dyskinesia improved in 312 cases, increased in 4 cases; no deaths. Postoperative complications: posterior occipital headache in 30 cases, cranial nerve injury in 2 cases, epidural cyst in 37 cases, cerebrospinal fluid leakage in 40 cases, intracranial infection in 51 cases, incision fat liquefaction in 45 cases. 170 cases of head and neck MRI examination showed: narrow syringomyelia. Follow-up 120 cases, time 0.5-6.5 years, an average of 2 years. The scores of KPS and ADL at the last follow-up were significantly higher than those before surgery (all P <0.01). The narrowing and disappearance rate of syringomyelia was 83.4%. Conclusion The improvement of posterior fossa decompression technique is safe and effective for the treatment of Chiari malformation type I and syringomyelia.