摘要
目的评价人工硬脑膜治疗ChiariI畸形合并脊髓空洞疗效及并发症。方法2002年6月～2004年6月收治ChiariI畸形合并脊髓空洞40例,均行枕大孔减压及硬膜成形术,其中20例应用人工硬脑膜行硬膜修补(人工硬膜组),余20例应用自体阔筋膜行硬膜修补(自体筋膜组)。结果术后半年2组临床症状改善均为17例(85.0%),无恶化。术后发热人工硬膜组12例(60.0%),自体筋膜组9例(45.0%),差异无显著性(χ2=0.902,P=0.342)。2组在手术时间[(3.6±0.7)hvs.(3.4±0.4)h,t=1.109,P=0.274]、术后发热的起始时间[(7.3±3.4)dvs.(9.4±2.5)d,t=-1.560,P=0.135]、持续时间(1～19d,vs.1～8d,中位数4.5dvs.2d,z=-1.643,P=0.100)、引流放置时间[(1.3±0.5)dvs.(1.2±0.4)d,t=0.230,P=0.820]及引流量(15～300mlvs.20～250ml,中位数80mlvs.37.5ml,z=-1.359,P=0.174)、术后应用抗生素的时间[(15.8±4.8)dvs.(13.7±1.5)d,t=1.260,P=0.223]、术后疗效评价均无显著差异,而应用激素的时间人工硬膜组(12.8±4.1)d长于自体筋膜组(7.8±3.1)d(t=3.055,P=0.007)。2组术后半年复查MR均无后颅窝积液。40例随访9个月～2年,自体筋膜组1例出现迟发伤口炎性肉芽肿,经清创治疗后治愈。结论ChiariI畸形合并脊髓空洞手术中,人工硬脑膜是可靠的修补硬膜替代物,疗效肯定。
Objective To evaluate the curative effects and complications of synthetic dural substitute （ Neuro - Patch） in the surgical treatment of Chiari type Ⅰ malformation （CMI） complicated with syringomyelia （SM）. Methods Forty patients suffered from CMI with SM were given foramen magnum decompression and duraplasty between June 2002 and June 2004. The duraplasty was performed using either synthetic dural substitute （ Neuro - Patch Group, n = 20） or autologous fascia lata （ Autologous Group, n = 20）. Results Symptoms were improved in 17 patients in both of groups （85.0%） at 6 months postoperatively, and no deterioration of symptoms was seen. Postoperative pyrexia occurred in 12 patients in the Neuro -Patch Group （60.0%） and 9 patients in the Autologous Group （45.0%）, without significant differences （X^2 = 0.902,P = 0. 342）. No statistically signi.ficant differences were observed between the Neuro - Patch Group and the Autologous Group in the operating time （3.6 ±0.7 h vs. 3.4 ±0.4 h; t = 1. 109, P=0.274）, the time to the onset of postoperative pyrexia （7.3 ±3.4 d vs. 9.4 ±2.5 d;t = - 1.560,P =0.135）, the length of duration of postoperative pyrexia （range, 1 -19 d vs. 1 -8 d, median, 4.5 d vs. 2 d;z = - 1. 643,P =0. 100） , the drainage time （1.3 ±0.5 d vs. 1.2 ±0.4 d; t=0.230, P=0.820）, the drainage volume （range, 15 -300 ml vs. 20-250 ml, median, 80 ml vs. 37.5 ml; z= - 1.359,P=0.174）, the duration of antibiotic administration （15.8±4.8 d vs. 13.7 ±1.5 d;t = 1.260,P = 0. 223） , and the assessment outcomes of curative effects. The length of duration of hormone requirement was longer in the Neuro - Patch Group （12.8±4. 1 d） than in the Autologous Group （7.8 ±3. 1 d） （t =3.055, P =0.007）. On MRI examinations at 6 postoperative months, no posterior cranial fossa effusion was detected in both of groups. Follow - up checkups for 9 months - 2 years in the 40 patients showed delayed infectious granuloma on the wound in 1 patient in the Autologou
出处
《中国微创外科杂志》
CSCD
2005年第11期931-932,942,共3页
Chinese Journal of Minimally Invasive Surgery
