摘要
目的探讨采用彩色多普勒超声评价ChiariⅠ畸形（CMI）寰枕减压硬膜成形术后疗效与枕大孔区脑脊液（CSF）流动恢复的关系。方法2008年12月~2009年4月ChiariⅠ畸形18例,其中合并脊髓空洞14例,男8例,女10例。年龄10~57岁,（42.3±13.1）岁。采用后正中入路枕大孔区减压硬膜成形术,用人工硬膜（Neuropatch）修补硬膜。于术后10~12天采用PHILLIP IU22彩色多普勒超声经枕部骨性减压窗测量小脑扁桃体下缘水平脊髓腹背侧蛛网膜下腔脑脊液的头向及尾向流动的流速。根据Tator评分评价术后效果对比分析术后改善组与术后稳定组CSF流速差异。术后MR复查脊髓空洞消减情况。结果患者均痊愈出院。出院前13例为优（改善组）,余5例为良（稳定组）。术后MRI示14例合并脊髓空洞者中10例有明显缩小（改善组7例,稳定组3例）,余4例无明显改变。彩色多普勒超声检查18例小脑扁桃体下缘水平脊髓背侧蛛网膜下腔均可见脑脊液的头向及尾向流动,与心动周期相关,尾向流速（8.52±5.28）cm/s[改善组（6.35±2.81）cm/s,稳定组（14.18±6.29）cm/s,t=-3.734,P=0.002],头向流速（6.42±2.17）cm/s[改善组（5.88±1.97）cm/s,稳定组（7.81±2.22）cm/s,t=-1.804,P=0.090）。结论寰枕减压硬膜成形术治疗CMI可有效恢复术后枕大孔区脑脊液流动,疗效肯定。彩色多普勒超声术后测量枕大孔区脑脊液流速恢复情况与疗效有一定关系。
Objective To evaluate the therapeutic effect and the circulation of cerebral spinal fluid（CSF） around the foramen magnum in Chiari malformation I（CMI） after atlanto-occipital decompression（AOD） with duraplasty by Color Doppler ultrasonography（CDU）.Methods Eighteen patients with CMI（8 males and 10 females,aged from 10 to 57 years with a mean of（42.3±13.1） were treated by AOD with duraplasty in our hospital between December 2008 and April 2009.Of the patients,14 were complicated with syringomyelia.All the patients were treated by AOC with duraplasty and then the dura mater was sutured with neuropatch.Ten to twelve days after the operation,all the cases underwent CDU（PHILLIP IU 22） to measure the maximum postoperative velocities of CSF in cranial-and caudal-direction in the arachnoid space below the TC.Therapeutic effects were evaluated by Tator score and the patients were divided into two groups according to the results（improved and stable groups）.The velocities of CSF were compared between the two groups.MRI was carried out after the surgery to evaluate the therapeutic outcomes.Results No patient died after the operation,there were 13 patients in the improved group and 5 patients in the stabled group.71%（10/14） of the patients who were complicated with syringomyelia（SM） showed decrease of SM by postoperative MRI（7 in improved group and 3 in stable group）,the others had no change in size.CDU showed that Caudal-directed flow rate of CSF in dorsal arachnoid space below the TC was（6.35±2.81） cm/s in improved group and（14.18±6.29） cm/s in stable group（t=-3.734,P=0.002）;cephalad-directed flow rate was（5.88±1.97） cm/s in improved group and（7.81±2.22） cm/s in stabled group（t=-1.804,P=0.090）.Conclusions AOD with duraplasty can effectively restore the circulation of CSF around the foramen magnum in CMI;CDU is a useful method to evaluate the flow of CSF in CMI.
出处
《中国微创外科杂志》
CSCD
2010年第2期156-159,共4页
Chinese Journal of Minimally Invasive Surgery
基金
北京大学第三医院中青年骨干基金项目(YZZ05-17-07)
关键词
CHIARI畸形
脊髓空洞症
彩色多普勒超声
手术减压
Arnold-Chiari malformation
Syringomyelia
Colored Doppler ultrasonography
Decompression
surgical
