贵州医科大学学报

2021, v.46;No.254(11) 1354-1359

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两种手术方式治疗ChiariⅠ型畸形合并脊髓空洞患者的疗效及对脑脊液流速的影响
The curative effects of two surgeries on type Chiari Ⅰ malformation complicated with synodynia and their influence on cerebrospinal fluid

崔政;郑虎林;王丙聚;
CUI Zheng;ZHENG Hulin;WANG Bingju;Department of Neurosurgery Ward 2,Yulin First Hospital;Department of Neurology,Xianyang Hospital of Yan'an University;

摘要(Abstract):

目的观察2种手术方式治疗ChiariⅠ型畸形合并脊髓空洞患者的疗效及对脑脊液流速的影响。方法 83例ChiariⅠ型畸形合并脊髓空洞患者根据手术治疗方式分为颅后窝组(n=40,行颅后窝成形术)与骨性减压组(n=43,行骨性减压术),比较2组患者的临床疗效及术后脊髓空洞改善情况,观察2组患者手术前后脑脊液的每搏输出量(SV)及平均流量(MF),检测手术前后血清神经营养因子(NGF)、脑源性神经营养因子(BDNF)、星型胶原蛋白(S100B)、神经胶质纤维酸性蛋白(GFAP),记录体感诱发电位(SSEPs)及运动诱发电位(TCeMEPs),统计术后并发症的发生情况。结果 2组患者疗效优良率比较,差异无统计学意义(P> 0.05);颅后窝组患者术后脊髓空洞改善率显著高于骨性减压组患者,差异有统计学意义(P<0.05);2组患者术后不同感兴趣区脑脊液的SV、MF水平高于术前(P<0.05),术后SSEPs波幅高于术前(P<0.05),术后血清NGF、BDNF水平高于术前,S100B、GFAP水平低于术前(P<0.05);颅后窝组术后并发症总发生率高于骨性减压组,差异有统计学意义(P<0.05)。结论颅后窝成形术与骨性减压术均能够改善ChiariⅠ型畸形合并脊髓空洞患者的神经功能、脑脊液流速,且临床疗效相当;颅后窝成形术可更好的促进脊髓空洞闭合、缩小,但术后并发症发生率较高。
Objective To observe the curative effects of two surgeries on Chiari type Ⅰ malformation complicated with synodynia and their influence on cerebrospinal fluid.Methods The clinical data of83 patients with Chiari type Ⅰ malformation complicated with syringomyelia were retrospectively analyzed,and the patients were divided into Group A(n=40) and Group B(n=43) according to different surgical therapies.Group A underwent posterior cranial fossa plasty after admission,and Group B underwent osteodecompression.The postoperative clinical efficacy and improvement of spinal cavity were compared between the two groups.The cardiac output(SV),average flow(MF),neurotrophic factor(NGF plays),brain derived neurotrophic factor(BDNF),star collagen(called S100 B),glial fibers acidic protein(GFAP),and neural electrophysiological detection somatosensory evoked potentials(SSEPs),transcranial electrical stimulation motor evoked potential(TCeMEPs),and the incidence of postoperative complications of the two groups were statistically observed and compared.Results There was no statistical significance in the excellent and good rates of curative effects between the two groups(92.50% vs 93.05%,P> 0.05).The postoperative syringomyelia improvement rate of Group A(87.50%) was significantly higher than that of Group B(51.16%),and the difference was statistically significant(P <0.05).After surgery the levels of SV and MF in the zone of disinterest and the amplitude of neuroelectrophysiological test SSEPS were higher than those before surgery in both groups,and the differences were both statistically significant(P <0.05).The levels of serum NGF and BDNF after surgery were higher than before surgery,while the levels of S100 B and GFAP were lower than those before surgery,with statistical significance(P <0.05).The total incidence of postoperative complications in Group A(37.50%) was higher than that in Group B(16.28%),with statistical significance(P <0.05).Conclusion Posterior cranial fossa plasty and osteodecompression can improve neurological function and cerebrospinal fluid in patients with Chiari I malformation combined with syringomyelia,with similar clinical efficacy,while posterior cranial fossa plasty can better promote the closure and shrinkage of syringomyelia,but the postoperative complication rate is high.

关键词(KeyWords): Chiari畸形;脊髓空洞;颅后窝成形术;骨性减压术;神经功能;脑脊液;安全性
Chiari malformation;syringomyelia;posterior fossa plasty;bony decompression;neural function;cerebrospinal fluid;security

Abstract:

Keywords:

基金项目(Foundation): 榆林市科学技术局[(2019)185号-34];; 陕西省教育厅基金项目(16JK1867)

作者(Authors): 崔政;郑虎林;王丙聚;
CUI Zheng;ZHENG Hulin;WANG Bingju;Department of Neurosurgery Ward 2,Yulin First Hospital;Department of Neurology,Xianyang Hospital of Yan'an University;

DOI: 10.19367/j.cnki.2096-8388.2021.11.019

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