合并Chiari—Ⅰ畸形的颈椎管狭窄症的手术治疗.pdfVIP

438 中国脊柱脊髓杂志 2008 年第 18 卷第6 期 Chinese }ourn a1 01 Spine and Spina1 Cord ,2oo8 , Vol.18 ,No.6 R~S雪理EZE 合并 Chi咀iaIr.← I 畸形的颈椎管狭窄症的手术治疗 王少泼，王圣林，王振宇 (北京大学第三医院骨科 100083 北京市) [摘要]目的:探讨合并 Chiari- 1 畸形的颈椎管狭窄症的治疗方式及效果。方法:回顾性分析 34 例合并 Chiari­ I 畸形的颈椎管狭窄症患者的临床资料，其中男 10 例，女 24 例:年龄 21-66 岁，平均 38.6 岁 ;27 例合并脊髓 空洞。均一期由神经外科医师行后颅窝减压术、骨科医师行颈后路椎管扩大成形术 22 例合并较大脊髓空洞者 同时进行空洞穿刺抽吸术。结果:34 例子术时间平均 155min 平均出血量 35仇nl: lO例术后出现轴性症状，2 例 发生脑脊液漏，经对症处理后治愈。 28 例术后获得 6 个月 -8 年(平均 2 年 10 个月)随访，按 Odom 疗效标准评 定，优 7 例，良 10 例，优良率为 60.7%0 6 例合并脊髓空洞的患者术后复查了 MRI ， 15 例患者的脊髓空洞消失， 2 6 例较术前明显缩小，5 例无改变。结论:对合并 Chiari- 1 畸形的颈椎管狭窄症患者一期行后颅窝减压和椎管 扩大成形术是有效的治疗方式。 [关键词]颈椎管狭窄症;Chiari- 1 畸形;手术 中图分类号:R68 1.5 ， R742.8 文献标识码:A 文章编号:1004-406X(2008)-06-0438-04 Cervical canal stenosis associated with Chiari - 1 malformationIWANG Shaobo ,WANG Shenglin , WANG Zhenyul/Chinese Journal of Spine and Spinal Cord ,2008 ,18(6) :438-441 [Abstractl Objec创ve: To evaluate the treatment methods and outcome of cervical canal stenosis associated with Chiari - 1 malfonnation.Method: 34 cases of cervical canal stenosis associated with Chiari - 1 malfonna- tion were studied retrospectively.Out of these , 10 were male and 24 were female ,with the mean age of 38.6 (range ,21 to 66 years) ,and 27 had syringomyelia.All cases underwent one stage operation of posterior fossa decompression (by neurosurgeon) and cervical laminopalsty (by spine surgeon) ,and 22 with syringomyelia un- derwent cavity puncture.Result: The mean operative time was 155 minutes ,and the mean blood loss was 350ml. 1O cases had axial symptoms after the procedure ,and 2 sufIered with CSF leakage ,which were cured by the heteropathy.According the Odom criterion ,with 2 years and 10 months follow-up ,7 cas