Wang Xin, Gao Jun, Wang Tianyu, Li Zhimin, Li Yongning
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
World Neurosurg. 2019 Feb;122:e443-e448. doi: 10.1016/j.wneu.2018.10.068. Epub 2018 Oct 19.
Previous studies have shown that the clivus angle gradient is significantly decreased in patients with Chiari malformation type I (CMI) with an associated syrinx compared with patients with CMI only and a healthy population. To date, the relationship between the clivus gradient and clinical outcomes has remained unclear. The objective of the present study was to investigate whether different clivus gradients (∠α) in CMI after posterior fossa decompression will lead to different clinical outcomes.
A total of 86 patients who had undergone surgical decompression at our institution from 2010 to 2016 were retrospectively divided into 2 groups: group A, with a gradient angle >44°, and group B, with an angle ≤44°. The patients' outcomes were determined using the Chicago Chiari Outcome Scale (CCOS).
Direct comparisons were made between the 2 groups. No statistically significant differences were found between the 2 groups in demographic data, preoperative symptoms, postoperative complications, or radiographic characteristics (P > 0.05), except for the length of the postoperative hospital stay (P = 0.006). The mean overall CCOS score was 12.80 ± 2.08. The total CCOS score was significantly different statistically between the 2 groups (P < 0.05). Moreover, group A demonstrated significantly better postoperative improvements compared with group B in the clinical outcome measures using the CCOS (P = 0.021).
A direct comparison between the 2 groups revealed that a decreased clivus gradient was related to unsatisfactory clinical outcomes. Thus, clivus gradients might emerge as a predictor of clinical outcomes after surgical decompression in patients with CMI.
既往研究表明，与仅患有I型Chiari畸形（CMI）的患者及健康人群相比，伴有脊髓空洞症的I型Chiari畸形（CMI）患者的斜坡角梯度显著降低。迄今为止，斜坡梯度与临床结局之间的关系仍不清楚。本研究的目的是调查后颅窝减压术后CMI患者不同的斜坡梯度（∠α）是否会导致不同的临床结局。
回顾性分析2010年至2016年在我院接受手术减压的86例患者，将其分为2组：A组，梯度角>44°；B组，角度≤44°。采用芝加哥Chiari结局量表（CCOS）评估患者的结局。
对两组进行直接比较。除术后住院时间外（P = 0.006），两组在人口统计学数据、术前症状、术后并发症或影像学特征方面均未发现统计学显著差异（P>0.05）。CCOS总平均分是12.80±2.08。两组的CCOS总分在统计学上有显著差异（P<0.05）。此外，在使用CCOS的临床结局指标方面，A组术后改善明显优于B组（P = 0.021）。
两组直接比较显示，斜坡梯度降低与临床结局不理想有关。因此，斜坡梯度可能成为CMI患者手术减压后临床结局的一个预测指标。
