【摘要】 目的探讨ChiariⅠ畸形的发病机制及手术疗效。方法收集浙江大学附属邵逸夫医院2011年12月至2015年12月所收治的ChiariⅠ畸形患者符合且相关研究条件的20例为研究对象,对照组选自该院门诊或急诊因头痛等原因行头颅薄层CT检查的正常患者20例,采用回顾性研究,分析后颅窝容积与ChiariⅠ畸形发病机制之间的关系,以及后颅窝减压术的疗效。结果 ChiariⅠ畸形患者后颅窝容积小于正常对照组[(176. 2±11. 5) cm~3vs(184. 9±11. 4) cm~3,t=2. 403,P=0. 021]。将ChiariⅠ畸形患者按小脑扁桃体下疝程度分为Ⅰ度、Ⅱ度、Ⅲ度三组,后颅窝容积在Ⅰ度、Ⅱ度Ⅲ度三组患者中无明显统计学差异[(170. 1±9. 9) cm~3vs (184. 3±6. 4) cm~3vs(174. 8±12. 0) cm~3,F=2. 232,P=0. 138]。后颅窝减压术疗效分析中,症状消失组与症状改善组后颅窝容积有明显统计学差异[(170. 9±10. 4) cm~3vs (181. 7±9. 6) cm~3,t=2. 306,P=0. 034]。结论 ChiariⅠ畸形患者后颅窝狭窄,可能是导致小脑扁桃体下疝的原因之一,但与小脑扁桃体下疝的严重程度无明显关系。后颅窝减压术治疗后,后颅窝容积越小者,预示着手术疗效可能越好。更多还原

【Abstract】 Objective To investigate the pathogenesis and surgery effect of Chiari malformation Type Ⅰ(CM-Ⅰ).Methods Twenty CM-Ⅰ patients meeting inclusion criteria treated in Sir Run Run Shaw Hospital between December2011 to December 2015 were retrospectively studied to explore the relationship between posterior cranial fossa volume(PFV) and CM-Ⅰ and the therapeutic effect of posterior fossa decompression. At the same time,20 normal outpatients undergoing thin-section computed tomographic(CT) scans for headache and other reasons were served as controls. Results The posterior fossa volume of CM-Ⅰ patients was smaller than that of normal group[(176. 2 ± 11. 5) cm~3 vs(184. 9 ±11. 4) cm~3,t = 2. 403,P = 0. 021]. CM-Ⅰ patients were divided into three groups according to the degree of cerebellar tonsil herniation: degree Ⅰ,Ⅱ and Ⅲ,and no differences in posterior fossa volume were found between patients of degreeⅠ,Ⅱ and Ⅲ. [(170. 1 ± 9. 9) cm~3 vs(184. 3 ± 6. 4) cm~3 vs(174. 8 ± 12. 0) cm~3,F = 2. 232,P = 0. 138]. There was a significant difference in therapeutic effect of posterior fossa decompression between symptom disappearance group and symptom improvement group[(170. 9 ± 10. 4) cm~3 vs(181. 7 ± 9. 6) cm~3,t = 2. 306,P = 0. 034]. Conclusion The posterior cranial fossa stenosis may be one of the causes of cerebellar tonsil herniation and is not obviously associated with its severity in CM-Ⅰ patients. When the posterior fossa decompression is performed for CM-Ⅰ patients,the smaller the posterior fossa volume is,the better the curative effect may be.更多还原