小脑扁桃体切除术在 Chiari 畸形 I 型后路减压术中的预后分析：一项多中心回顾性研究。
Prognostic analysis of posterior fossa decompression with or without cerebellar tonsillectomy for Chiari malformation type I: a multicenter retrospective study.
机构信息
1Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hu Bei.
2Department of Neurosurgery, Taihe Hospital, Jinzhou Medical University Union Training Base, Shiyan, Hu Bei.
出版信息
Neurosurg Focus. 2023 Mar;54(3):E4. doi: 10.3171/2022.12.FOCUS22626.
OBJECTIVE
The purpose of this study was to compare the prognosis of patients with Chiari malformation type I (CM-I) treated with posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression with resection of tonsils (PFDRT).
METHODS
The clinical data of patients with CM-I treated using these two procedures in three medical centers between January 2016 and June 2021 were retrospectively analyzed and divided into PFDD and PFDRT groups according to the procedures. The Chicago Chiari Outcome Scale (CCOS) was used to score the patients and compare the prognosis of the two groups.
RESULTS
A total of 125 patients with CM-I were included, of whom 90 (72.0%) were in the PFDD group, and 35 (28.0%) were in the PFDRT group. There was no significant difference in the overall essential characteristics of the two groups. Moreover, there was no significant difference in complication rates (3.3% vs 8.6%, p = 0.348), CCOS scores (13.5 ± 1.59 vs 14.0 ± 1.21, p = 0.111), and the probability of poor prognosis (25.6% vs 11.4%, p = 0.096) between the two groups. Nevertheless, a subgroup of patients who had CM-I combined with syringomyelia (SM) revealed higher CCOS scores (13.91 ± 1.12 vs 12.70 ± 1.64, p = 0.002) and a lower probability of poor prognosis (13.0% vs 40.4%, p = 0.028) in the PFDRT than in the PFDD group. Also, SM relief was more significant in patients in the PFDRT compared to the PFDD group. A logistic multifactor regression analysis of poor prognosis in patients with CM-I and SM showed that the PFDRT surgical approach was a protective factor compared to PFDD. Furthermore, by CCOS analysis, it was found that the main advantage of PFDRT in treating patients with CM-I and SM was to improve patients' nonpain and functionality scores.
CONCLUSIONS
Compared with PFDD, PFDRT is associated with a better prognosis for patients with CM-I and SM and is a protective factor for poor prognosis. Therefore, the authors suggest that PFDRT may be considered for patients with CM-I and SM.
目的
本研究旨在比较 Chiari 畸形 I 型（CM-I）患者行颅后窝减压伴硬脑膜成形术（PFDD）与行颅后窝减压伴扁桃体切除术（PFDRT）的预后。
方法
回顾性分析 2016 年 1 月至 2021 年 6 月在 3 家医疗中心采用这两种手术治疗的 CM-I 患者的临床资料，并根据手术方式分为 PFDD 组和 PFDRT 组。采用芝加哥 Chiari 结局量表（CCOS）对患者进行评分，并比较两组的预后。
结果
共纳入 125 例 CM-I 患者，其中 90 例（72.0%）行 PFDD，35 例（28.0%）行 PFDRT。两组患者的一般特征总体无显著差异。此外，两组的并发症发生率（3.3%比 8.6%，p=0.348）、CCOS 评分（13.5±1.59 比 14.0±1.21，p=0.111）和预后不良的概率（25.6%比 11.4%，p=0.096）均无显著差异。然而，在伴有脊髓空洞症（SM）的 CM-I 患者亚组中，PFDRT 组的 CCOS 评分（13.91±1.12 比 12.70±1.64，p=0.002）更高，预后不良的概率（13.0%比 40.4%，p=0.028）更低。此外，PFDRT 组患者的 SM 缓解程度优于 PFDD 组。多因素 logistic 回归分析显示，PFDRT 手术方式是 CM-I 合并 SM 患者预后不良的保护因素。此外，通过 CCOS 分析发现，PFDRT 治疗 CM-I 合并 SM 的主要优势在于改善患者的非疼痛和功能评分。
结论
与 PFDD 相比，PFDRT 可改善 CM-I 合并 SM 患者的预后，是预后不良的保护因素。因此，作者建议对 CM-I 合并 SM 的患者考虑行 PFDRT。
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