枕大池成形术对Chiari畸形Ⅰ型伴脊髓空洞症患者脑脊液流体力学的影响

发布时间：2018-03-06 08:14

本文选题：Arnold-Chiari畸形　切入点：脊髓空洞症　出处：《四川医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:使用磁共振(Magnetic Resonance Imaging,MRI)相位对比电影成像技术(cine PC)探讨枕大池成形术(后颅窝减压+小脑扁桃体切除+枕大池硬膜成形)对Chiari畸形Ⅰ型伴脊髓空洞症患者脑脊液流体力学的影响,并评价手术疗效。方法:选取临床确诊为Chiari畸形Ⅰ型伴脊髓空洞症患者共40例,均行枕大池成形手术治疗。采用Philips 3.0T超导型磁共振机相位对比电影序列对所有患者术前24h及术后12个月行脑脊液流体力学定性及定量检测。层面选择:①中脑导水管层面②脑桥腹侧平面③颈3(C3)腹侧平面。定量测量指标:①每搏输出量:Stroke volume(SV)。②平均流量:Mean flux(MF)。③返流分数:Regurgitant Fraction(%)。④最大峰值流速:Peak velocity(Vmax)。⑤RR间期:RR Interval(ms)。统计分析其手术前后的变化,并对比手术前后患者JOA评分,评价手术疗效。结果:术前定性观察显示脑脊液流动呈与心脏舒缩相关的双向流动,心脏收缩期脑脊液从头侧流向尾侧,舒张期脑脊液从尾侧流向头侧。Chiari畸形Ⅰ型伴脊髓空洞症患者枕骨大孔后缘空间阻塞严重,枕大池消失,脑脊液流动信号几乎消失,10例患者脊髓空洞内液体与蛛网膜下腔脑脊液信号改变同步,证实空洞腔与脊髓蛛网膜下腔相通;术后没有患者出现神经功能恶化或死亡,PC-MRI扫描显示枕大池成形良好,脊髓蛛网膜下腔通畅,枕骨大孔后缘脑脊液信号恢复,30例患者脊髓空洞明显缩小,8例患者脊髓空洞轻微缩小,2例患者脊髓空洞未见明显变化;所有患者JOA评分增加,脑脊液每搏输出量、平均流量增加,双向最大峰值流速均减小,尤其C3层面更为明显,差异比较均具有统计学意义(P0.05)。结论:枕大池成形术可以增加病变区脑脊液流量,减缓脑脊液峰值流速,减轻脊髓空洞,改善患者预后,是一种有效的术式。
[Abstract]:Objective: to investigate the effect of Cisternoplasty (posterior cranial fossa decompression and cerebellar tonsillectomy of occipital cistern dural formation) on patients with Chiari malformation type I with syringomyelia by using magnetic Resonance imaging phase contrast film imaging technique. The effect of hydrodynamics, Methods: 40 cases of syringomyelia with Chiari deformity type I were selected. All patients were treated with occipital cisternoplasty. Philips 3.0T superconducting magnetic resonance machine phase contrast film sequence was used to detect cerebrospinal fluid hydrodynamics qualitatively and quantitatively in all patients 24 hours before operation and 12 months after operation. The ventral plane of 2 pontine (3 neck 3) was measured quantitatively. The mean flow rate of 1: 1 stroke volume(SV).2 was 1: mean flux(MF).3 reflux fraction:: peak peak velocity of: peak velocity(Vmax).5RR interval: RR intervalmssis.The changes before and after operation were analyzed statistically, and the mean flow rate of 1: 1 stroke volume(SV).2 was measured before and after the operation, and the mean flow rate was: mean flux(MF).3 reflux fraction:% Regurgitant Fraction(%).4 maximal peak velocity: peak velocity(Vmax).5RR interval: RR intervalmsm. Results: before and after operation, cerebrospinal fluid flow showed a two-way flow associated with cardiac systolic and diastolic flow, and the contractile cerebrospinal fluid flowed from the head to the caudal side. Diastolic cerebrospinal fluid flowed from tail to head side. Chiari malformation type I with syringomyelia had severe obstruction of posterior margin of foramen magnum and disappeared of cistern magnum occipitalis. Cerebrospinal fluid flow signal almost disappeared in 10 patients with syringomyelia and subarachnoid cerebrospinal fluid signal changes synchronously, confirmed that the cavity and spinal subarachnoid cavity interlinked; PC-MRI scan showed that the cistern was well formed and the subarachnoid space of the spinal cord was unobstructed. Signal recovery of cerebrospinal fluid in posterior margin of occipital foramen in 30 patients with significant reduction of syringomyelia in 8 patients, slight reduction of syringomyelia in 8 patients and no significant change in syringomyelia in 2 patients, the JOA score of all patients was increased, and cerebrospinal fluid output per stroke was increased. With the increase of mean flow rate, the maximum flow velocity in both directions decreased, especially on C3 level. The difference was statistically significant (P 0.05). Conclusion: Cisteroplasty can increase the flow of cerebrospinal fluid and slow down the peak velocity of cerebrospinal fluid in the lesion area. Reducing syringomyelia and improving prognosis is an effective procedure.
【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

【相似文献】