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目的采用新方法再探讨ChiariⅠ型畸形的诊断标准。方法利用医用计算机图像处理软件0SIRIS,对27例小脑扁桃体下疝超过5mm的ChiariⅠ型畸形病例、25例小脑扁桃体下疝<3mm的可疑ChiariⅠ型畸形病例以及40例不伴中枢神经系统疾病的患者的头颅MRI图像分别进行颅腔和脑实质的径线与面积的测量,并对测量结果作统计学分析。所选病人均在18岁以上,MRI资料完整,不伴颅内高压、环枕融合和颅底凹陷。结果ChiariⅠ型畸形可疑组的枕底长与斜坡长的比值明显大于ChiariⅠ型畸形组(P<0.05),后脑面积与后颅窝面积的比值明显小于ChiariⅠ型畸形组(P<0.05),而这2项测量结果与对照组之间差异无显著性(P>0.05);此外,可疑组的后脑面积与大脑面积及大脑面积与幕上颅腔面积的比值与对照组和ChiariⅠ型畸形组间差异均无显著性(P>0.05)。结论ChiariⅠ型畸形以小脑扁桃体下疝超过5mm为诊断标准较为合理,下疝<3mm应视为正常。该研究结果也支持后颅窝骨发育不良导致后颅窝过度拥挤是ChiariⅠ型畸形发病机制的学说。
Objective To explore the diagnostic criteria of Chiari Ⅰ deformity by new method. Methods Twenty-seven cases of Chiari Ⅰ deformity with 27 cases of tonsil herniation over 5mm, 25 cases of suspected Chiari Ⅰ malformation of cerebellar tonsil herniation <3 mm, and 40 cases of patients without central nervous system diseases were analyzed using medical computer image processing software 0SIRIS. Head MRI images of the cranial cavity and brain parenchyma diameter and area measurement, and measurement results for statistical analysis. Selected patients were over 18 years of age, MRI data is complete, without intracranial hypertension, annular fusion and skull base depression. Results The ratio of occiput length to slope length was significantly higher in suspected Chiari Ⅰ deformity group than in Chiari Ⅰ deformity group (P <0.05), and the ratio of posterior cerebral area to posterior fossa area was significantly lower than that in Chiari Ⅰ deformity group (P <0.05) There was no significant difference between the two measurement results and the control group (P> 0.05). In addition, the ratio of the area of the back brain to the area of the brain and the area of the supratentorial cranial area in the suspicious group were significantly different from those in the control group and the Chiari Ⅰ type No significant (P> 0.05). Conclusion Chiari Ⅰ deformity with cerebellar tonsil hernia more than 5mm diagnostic criteria is more reasonable, the hernia <3mm should be considered normal. The findings also support the hypothesis that posterior fossa dysplasia leads to posterior fossa overcrowding as the pathogenesis of Chiari type I deformity.