Chiari畸形Ⅰ型的两种手术方式及疗效对比

发布时间：2018-03-05 23:31

本文选题：Chiari畸形I型　切入点：单纯后颅窝减压术　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:对Chiari畸形I型两种不同术式的疗效进行回顾性分析,通过比较两种术式的利弊,制定出一套更适合患者的个性化手术治疗方案。方法:严格筛选新疆医科大学第一附属医院神经外科于2014年6月至2016年6月收治的经手术治疗的Chiari畸形I型患者79例,失访5例,共纳入研究74例。将其分为A、B两组,其中A组行单纯后颅窝骨性减压术,B组在A组手术的基础上行硬膜扩大修补术+小脑扁桃体切除术,对两组患者术后的疗效进行分析评估。结果:74例手术患者中,其中男24例,女50例,A组患者34例,B组患者40例,A组患者手术有效率达到82.4%,其中仅1例出现术后并发症,B组术后好转率为80.0%,但术后并发症高于A组,将两组术后的疗效数据进行统计学卡方检验(X2=0.07,P0.05),得出两组之间无统计学意义。结论:两组手术方式治疗Chiari畸形I型对术后脊髓空洞的恢复及临床症状的改善均有一定疗效,单纯后颅窝减压术的有效率高于小脑扁桃体切除术,而且小脑扁桃体切除术后并发症多于单纯后颅窝减压术,且平均住院天数高,单纯后颅窝骨性减压术操作相对简单安全、有效,我们认为对有症状的Chiari畸形I型患者选择单纯后颅窝减压术更安全有效。
[Abstract]:Objective: to retrospectively analyze the curative effect of two different operative methods of Chiari malformation type I, and compare the advantages and disadvantages of the two methods. Methods: 79 cases of Chiari type I malformation treated in neurosurgery department of the first affiliated Hospital of Xinjiang Medical University from June 2014 to June 2016 were selected strictly. The patients were divided into two groups: group A was treated with simple posterior cranial fossa decompression and group B was treated with expanded dural repair on the basis of operation in group A, and cerebellar tonsillectomy was performed on the basis of the operation in group A. Results among 74 patients, 24 were male. The effective rate of operation in group A was 82.4%, and the improvement rate of group B was 80.0%, but the postoperative complication was higher than that of group A. Statistical chi-square test was used to test the curative effect data of the two groups. The results showed that there was no statistical significance between the two groups. Conclusion: the two groups of surgical treatment of Chiari deformity type I have a certain curative effect on the recovery of syringomyelia and the improvement of clinical symptoms. The effective rate of simple posterior cranial fossa decompression was higher than that of cerebellar tonsillectomy, and the complication after cerebellar tonsillectomy was more than that of simple posterior cranial fossa decompression, and the average hospital stay was high. The simple posterior cranial fossa decompression was relatively simple and safe. We believe that simple posterior fossa decompression is more safe and effective for patients with symptomatic type I Chiari malformation.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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