摘要
目的 探讨 Ａｒｎｏｌｄ Ｃｈｉａｒｉ 畸形合并脊髓空洞症 （ Ａ Ｃ Ｍ／ Ｓ Ｍ） 的发病 机理， 寻求更好的手术方法。方法 对１４ 例 Ａ Ｃ Ｍ／ Ｓ Ｍ 的患者进行 Ｍ Ｒ Ｉ检查及术前奎科试验， 术中枕大池、空洞及脊髓蛛网膜下腔 （ Ｓ Ｓ Ａ Ｓ） 压力测量， 分析与空洞形成及大小相关的因素， 对单纯 Ａ Ｃ Ｍ 及 Ｈ Ｃ Ｉ（ 正中矢状面最宽处空洞与脊髓直径比值） ＜ ０５ 者行枕下颅骨切除＋ 硬膜扩大修补术 （ Ａ） ； Ａ Ｃ Ｍ／ Ｓ Ｍ 且 Ｈ Ｃ Ｉ≥０５者行 Ａ＋ 空洞蛛网膜下腔（ Ｓ Ｓ） 分流术（ Ｂ） 。结果 １４ 例患者均有不同程度的颈部位置性梗阻。空洞内液体与 Ｃ Ｓ Ｆ蛋白含量无显著差异（ Ｐ ＞ ００５） ， 小脑扁桃体下疝的程度与空洞大小无显著线性关系（ Ｐｒ１ ＞ ０５ ， Ｐｒ２ ＞ ０２） ； 枕大池与椎管蛛网膜下腔压力差与空洞大小呈显著正相关（ Ｐｒ３ ＜ ０１ ， Ｐｒ４＜ ０００５） 。手术有效率为９３８ ％ 。结论 脑脊液动力学改变是脊髓空洞形成的关键， 当后颅窝与椎管内压力梯度达到一定值时， 脊髓空洞开始形成。治疗应根据 Ａ Ｃ Ｍ 是否伴有 Ｓ Ｍ 及 Ｓ Ｃ Ｉ值选择恰当的手术方法。
Objective To explore the pathogenisis of syringomyelia in Arnold Chiari maformation and seek for the more effective surgical treatment.Methods MRI and Queckensted test were done in 14 patients. The pressure of cisternal, syrinx and subarchnoid spaces were measured during operation. The factors related to produce and size of syrinx were analysed. Patients who suffered from merely ACM and HCI<0 5 were performed craniovertebral decompression and posterior fossa reconstruction (A); The others who suffered from ACM associated with SM were performed (A) and syringx subarachiod spaces shunt. Results All of the patients show cervical postural blockage , the protien quantity of liquid in syringx and CSF is no significant difference (P>0 05). The extent of tonsil herniation has no linear relation to the size of syrinx (Pr1>0 2, Pr2>0 2). The pressure difference of cesternal and spinal subarchnoid spaces shows positive relation to the size of syrinx(Pr3<0 1, Pr4>0 005). The effective ratio of operation is 93 8%.Conclusion The hydrodynamic change of CSF play a important role in syrinx formation. When the craniospinal pressure gradient come to certain extent, the syrinx begin to produce. According to ACM whether or not associated with SM and HCI selecting surgical tratment is very important.
出处
《中华神经外科杂志》
CSCD
北大核心
1999年第5期278-281,共4页
Chinese Journal of Neurosurgery
