| ObjectiveTo compare and analyze the clinical effects of three surgical methods(PFD,PFDD and PFDRT)in the treatment of Chiari malformation type I patients with syringomyelia,and explore their advantages and disadvantages,so as to provide some basis for the clinical diagnosis and treatment of the disease.MethodsAccording to the electronic medical record,the clinical data of Chiari malformation type I who underwent surgical treatment in the Department of Neurosurgery,the First Affiliated Hospital of Kunming Medical University from January 2017 to December 2021 were queried.According to the inclusion and exclusion criteria,a total of 83 patients were included.According to the different surgical methods,they were divided into simple posterior fossa bone decompression(PFD group),posterior fossa bone decompression combined with duraplasty(PFDD group)and cerebellar tonsillectomy(PFDRT group).The basic information,surgical information,hospitalization information and follow-up information of the patients included in the study were recorded.Use SPSS 26 tool to conduct statistical analysis on the collected data.ResultsAll 83 patients who participated in this study successfully completed the posterior cranial fossa decompression operation.【1】 Comparison of the basic data(sex,age,course of disease)of the three groups of patients: there was no statistically significant difference among the three groups(P>0.05),among which the proportion of men and women in the three groups was close to 1:3,and the average course of disease in the three groups was 36.6 ± 46.4 months;Comparison of preoperative clinical data(headache,limb and trunk pain symptoms,sensory abnormalities,muscle weakness,muscle atrophy,ataxia): There was no statistically significant difference between the three groups [2] Comparison of preoperative imaging data(whether skull base depression,atlanto-occipital fusion,cerebellar tonsil hernia length,syringomyelia length,maximum syringomyelia diameter): there was no statistically significant difference(P>0.05).【3】 In the comparison of the three groups of surgical indicators(operation time,bleeding volume,postoperative hospital stay,and total cost of hospitalization),the differences of various indicators between the three groups were statistically significant(P,The difference was statistically significant(P=0.000 < 0.05);The average operation time of PFD group was significantly lower than that of PFDRT group(85.3 ±14.4 minutes),the difference was statistically significant(P=0.000<0.05),while the average operation time of PFDD group was significantly lower than that of PFDRT group(58.9 ± 17.2 minutes)(P=0.004<0.05);The median blood loss in PFD group(75ml)was significantly lower than that in PFDRT group(100ML),with a statistically significant difference(P=0.002 < 0.05);The median postoperative hospital stay in PFD group(10.5 days)was significantly shorter than that in PFDRT group(14 days),with a statistically significant difference(P=0.001<0.05);There was no significant difference between the other two groups in different surgical indicators(P>0.05).【4】Whether the CCOS score was improved at 3 months and 12 months after operation,there was no statistically significant difference between the three groups(P>0.05)[5]Whether the syringomyelia was significantly improved at 3 months after operation,there was a statistically significant difference between the three groups(P=0.009 <0.05),compared in pairs: the obvious improvement rate of syringomyelia at 3 months after operation in PFDRT group(82.2%)was significantly higher than that in PFD group(44.4%),P=0.003 < 0.05).There was also a statistically significant difference in the disappearance rate of syringomyelia in the 12 months after operation between the two groups(P=0.003 < 0.05).The comparison results of the two groups showed that the disappearance rate of syringomyelia in the 12 months after operation in the PFDD group(50%)was significantly higher than that in the PFD group(16.7%),P=0.043 <0.05;The cavity disappearance rate(64.4%)in PFDRT group was significantly higher than that in PFD group at 12 months after operation(P=0.001<0.05).【6】 In terms of complications: the difference of postoperative fever,any obvious postoperative complications and the incidence rate of subcutaneous hydrops among the three groups(P<0.05)was statistically significant.The difference of postoperative fever rate between PFDD group and PFDRT group P=0.006 < 0.05,and the difference between PFD group and PFDRT group P=0.005 < 0.05,that is,the fever rate of PFDRT group(66.7%)was significantly higher than that of PFDD group(30%)and PFD group(27.8%);In terms of any obvious postoperative complications,the incidence of obvious postoperative complications in PFDRT group(66.7%)was significantly higher than that in PFDD group(25%),P=0.032 < 0.05,and PFDRT group was also significantly higher than that in PFD group(5.6%),P=0.005 < 0.05.The incidence of postoperative subcutaneous hydrops in PFDRT group(37.8%)was significantly higher than that in PFDD group(20%),P=0.023<0.05;PFDRT group was significantly higher than PFD group(0%),P=0.001<0.05.Conclusion1.Although the difference of PFD/PFDD/PFDRT in the final clinical prognosis score of CCOS is not significant,their advantages and disadvantages can be clearly compared;2.Although PFDRT can better promote the regression of syringomyelia,the high incidence of complications is an important factor affecting the clinical prognosis of patients.When selecting this operation,the preoperative imaging data should be carefully evaluated;Although the complication rate of PFD surgery is low and simple and economical,the effect of simple bone decompression in relieving syringomyelia is far from enough,so we only recommend PDF surgery for patients with syringomyelia that is not obvious;3.PFDD surgery has the advantages similar to PFDRT surgery,which can better promote cavity regression,but also has the characteristics of low incidence of complications.Therefore,for most CMI patients with syringomyelia,we generally recommend PFDD surgery as the preferred surgical scheme. |
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