论文部分内容阅读
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 pathogenesis of Arnold Chiari malformation associated with syringomyelia (A C M / S M) and to find a better surgical method. Methods M R I test and preoperative Quaker test were performed in 14 cases of A C M / S M patients. The pressure, pressure and volume of the cistern and parietal cavity, Size related factors, simple A C M and H C I (the median sagittal cavity and spinal cord diameter ratio at the widest point) <0.5 were suboccipital skull excision + dilatation repair surgery (A); A C M / S M and H C I ≥ 0.5 5 line A + cavity - subarachnoid (SS) shunt (B). Results All 14 patients had different degrees of cervical positional obstruction. There was no significant difference (P> 005) between the content of liquid and the content of C S F protein in the cavity, and there was no significant linear relationship between the extent of the tonsil herniation and the size of the cavity (Pr 1> 05, Pr 2> 02) Spinal subarachnoid pressure difference was positively correlated with the size of the cavity (Pr3 <01, Pr4 <0005). The operative efficiency was 938%. Conclusions Cerebrospinal fluid dynamics is the key to the formation of syringomyelia. When the pressure gradient in posterior fossa and spinal canal reaches a certain value, syringomyelia begins to form. Treatment should be based on A C M with S M and S C I value to choose the appropriate surgical methods.