脊柱侧弯_____脊柱侧弯；

脊柱侧弯并发Chiari畸形的手术治疗

http://www.100md.com 《中国矫形外科杂志》 2006年第7期

脊柱侧弯,,脊柱侧弯；,Chiari畸形；,脊髓空洞症；,手术治疗,1临床资料,2结果,3讨论,参考文献：

     摘要：[目的]探讨脊柱侧弯并发Chiari畸形的诊断和治疗方法。[方法]本组12例脊柱侧弯并发Chiari畸形的患者，其中有7例同时伴有脊髓空洞症，所有患者均先由神经外科行枕大孔扩大成形术或空洞分流术，二期行脊柱侧弯后路矫形术。[结果]Cobbs角术前平均71°，术后平均24°，矫正率为66%。脊柱矫形术后随访1~4 a，平均24 a，没有发生脱钩、断钉及假关节现象；没有出现新的神经损害表现；感觉障碍及腹壁浅反射减弱的症状没有加重。[结论]对于脊柱侧弯并发Chiari畸形、脊髓空洞症的患者，术前应完善检查、明确诊断；先进行枕大孔扩大成形术或空洞分流术，二期行脊柱侧弯后路矫形术，可以减少脊柱侧弯矫形时引起的神经损害并发症。

    关键词：脊柱侧弯； Chiari畸形；脊髓空洞症；手术治疗

    Surgical treatment of scoliosis associated with Chiari malformation∥LI Zhanchun，LIU Zude,LI ZhanyuOrthopedic Department,Affiliated Renji Hospital,Shanghai Second Medical University,Shanghai 200001

    Abstract：[Objective]To discuss the diagnosis and treatment method of scoliosis associated with Chiari malformation[Method]Twelve patients were suffered from scoliosis associated with Chiari malformation,in which there were 7 patients also complicated with syringomyeliaFirstly,posterior suboccipital craniectomy to enlarge foramen occipital magnum was performed,then the patients underwent the scoliosis correction with instrumentation[Result]Preoperatively,the mean Cobbs angle on the coronal plane was 71°,and 24° postoperatively,with an average correction of 66%During a followup from 1 year to 4 years,there were no release of the hook,no breaking of pedicle screw,no false articulation and no new nervous lesion,while few improving was found about the sensory disability and superficial abdominal hyporeflexia[Conclusion]We should first consummate the examination and make a definite diagnosis for the patients who were suffered from scoliosis associated with Chiari malformation and syringomyelia;posterior suboccipital craniectomy to enlarge foramen occipital magnum or syrinxsubarachnoid space shunting should be performed firstly to reduce nervous lesion during scoliosis correction surgery ......

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