Chiari畸形1型合并脊髓空洞症手术预后分析

doi:10.3969/j.issn.1672-6731.2021.07.009

摘要/Abstract

摘要：

目的筛查Chiari畸形1型（CM1）合并脊髓空洞症患者行颅后窝减压术联合硬膜成形术后预后不良的危险因素。方法纳入2013年1月至2020年6月在武汉大学中南医院行颅后窝减压术联合硬膜成形术的47例CM1型合并脊髓空洞症患者，术后6个月采用传统评价标准和芝加哥Chiari畸形预后量表（CCOS）评价手术疗效，单因素和多因素Logistic回归分析筛查颅后窝减压术联合硬膜成形术后预后不良的相关危险因素。结果 47例患者根据CCOS评分分为治愈组（21例，CCOS评分为13~16）和未治愈组（26例，CCOS评分为4~12），未治愈组患者病程长于（t=4.709，P=0.000）、脊髓空洞宽度大于（t=3.074，P=0.004）治愈组。多因素Logistic回归分析显示，仅病程≥ 36个月是颅后窝减压术联合硬膜成形术后预后不良的危险因素（OR=21.948，95% CI：3.850~125.117；P=0.001）。结论病程≥ 36个月是CM1型合并脊髓空洞症患者颅后窝减压术联合硬膜成形术预后不良的危险因素，建议有明显症状的CM1型合并脊髓空洞症患者尽早手术治疗。

关键词: Arnold-Chiari畸形, 脊髓空洞症, 神经外科手术, 预后, 危险因素, Logistic模型

Abstract:

Objective To investigate the risk factors for poor prognosis of patients with Chiari malformation type 1 (CM1) complicated with syringomyelia treated by posterior fossa decompression with duraplasty (PFDD). Methods Forty-seven patients with CM1 complicated with syringomyelia who underwent PFDD at Zhongnan Hospital of Wuhan University from January 2013 to June 2020 were included. The prognosis was evaluated by the traditional evaluation criteria and Chicago Chiari Outcome Scale (CCOS) at 6 months postoperatively, and univariate and multivariate stepwise Logistic regression analyses were performed to screen for risk factors associated with poor outcome. Results Based on whether the CCOS score was greater than 12, 47 patients were divided into the cured group (n=21) and uncured group (n=26). Patients in the uncured group had longer disease duration (t=4.709, P=0.000) and greater syringomyelia width (t=3.074, P=0.004) than the cured group. Multivariable Logistic regression analysis showed that the long duration of disease (≥ 36 months) was an independent risk factor for poor surgical prognosis of patients after PFDD (OR=21.948, 95%CI:3.850-125.117; P=0.001). Conclusions Long duration of disease is an independent risk factor for poor surgical prognosis in patients with CM1 complicated with syringomyelia treated by PFDD, and early surgical treatment is recommended for the patients with symptomatic CM1 complicated with syringomyelia.

Key words: Arnold-Chiari malformation, Syringomyelia, Neurosurgical procedures, Prognosis, Risk factors, Logistic models

蔡远坤, 李帼, 刘征, 刘暌. Chiari畸形1型合并脊髓空洞症手术预后分析[J]. 中国现代神经疾病杂志, 2021, 21(7): 581-585.

CAI Yuan-kun, LI Guo, LIU Zheng, LIU Kui. Prognostic analysis of surgical treatment of Chiari malformation type 1 complicated with syringomyelia[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2021, 21(7): 581-585.

http://journal11.magtechjournal.com/cjcnn/CN/Y2021/V21/I7/581

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