后颅窝减压术治疗Chiari I型畸形对脊柱侧弯的影响。
Effect of Posterior Fossa Decompression for Chiari Malformation-I on Scoliosis.
作者信息
Chotai Silky, Basem Jade, Gannon Stephen, Dewan Michael, Shannon Chevis N, Wellons John C, Bonfield Christopher M
机构信息
Division of Pediatric Neurosurgery, Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.
出版信息
Pediatr Neurosurg. 2018;53(2):108-115. doi: 10.1159/000485254. Epub 2018 Jan 4.
BACKGROUND/AIMS: Scoliosis is common in patients with Chiari malformation-I (CM-I). This study examined the change in scoliosis severity after posterior fossa decompression (PFD) for CM-I.
METHODS
We conducted a retrospective review at a single tertiary center for children undergoing PFD with untreated scoliosis, and identified 17 patients with complete follow-up data and imaging.
RESULTS
Overall, scoliosis improved in 7 (41.2%) patients, worsened in 9 (52.9%), and remained unchanged in 1 (5.9%) after PFD (mean follow-up of 7.8 ± 4.1 months). We found that 3 of the 8 (38%) children with early-onset scoliosis eventually needed scoliosis corrective surgery, which was needed in 7 of the 9 (78%) patients with adolescent-onset scoliosis. In addition, only 1 patient (17%) with a preoperative scoliosis curve <35 degrees and 9 patients (82%) with a curve ≥35 degrees required surgery for scoliosis correction despite PFD (p = 0.018).
CONCLUSION
In certain patients, PFD for CM-I may lead to improvement or stabilization of scoliosis.
背景/目的：脊柱侧弯在 Chiari 畸形 I 型（CM-I）患者中很常见。本研究探讨了 CM-I 患者行后颅窝减压术（PFD）后脊柱侧弯严重程度的变化。
方法
我们在一家单一的三级中心对接受 PFD 且未治疗脊柱侧弯的儿童进行了回顾性研究，确定了 17 例有完整随访数据和影像学资料的患者。
结果
总体而言，PFD 后 7 例（41.2%）患者的脊柱侧弯有所改善，9 例（52.9%）患者的脊柱侧弯加重，1 例（5.9%）患者的脊柱侧弯保持不变（平均随访 7.8±4.1 个月）。我们发现，8 例（38%）早发性脊柱侧弯儿童中有 3 例最终需要进行脊柱侧弯矫正手术，9 例（78%）青少年期脊柱侧弯患者中有 7 例需要进行该手术。此外，尽管进行了 PFD，但术前脊柱侧弯角度<35 度的患者中只有 1 例（17%）、脊柱侧弯角度≥35 度的患者中有 9 例（82%）需要进行脊柱侧弯矫正手术（p = 0.018）。
结论
在某些患者中，CM-I 的 PFD 可能会导致脊柱侧弯改善或稳定。
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