The Application Study Of A Preoperative Comprehensive Scoring Method Based On Retrospective Analysis Of Three Surgical Methods Of CHIARI Ⅰ Deformity

Objective: To analysis the therapeutic effect of chiariⅠmalformation surgery Retrospectively and explore the application value of preoperative scoring criteria in the selection of surgical methods.Methods: There is a retrospective analysis of 60 cases of ChiariⅠmalformation diagnosed in Anhui Provincial Hospital from July 2015 to July 2019.All 60 patients underwent surgical treatment and were followed up regularly through outpatient clinics.Some patients were followed up successfully by telephone.The follow-up period was half year to three years.The Chicago-Chiari Prognostic Scale(CCOS)was used to assess prognosis.According to the surgical method performed by the patients,they were divided into posterior fossa decompression(PFD)A group of 12 cases,posterior fossa decompression with duralplasty(PFDD)B group of17 cases,and cerebellar tonsillectomy C group of 32 cases,then we analyze the CCOS data,and comparing related complications of the three groups after surgery.Each case is scored,somehow accord to the preoperative scoring standard(total score 12 points).According to the scoring results,all cases are scored and divided into low group 23 cases(less than 6points)and high group 37 cases(greater than 6 points).The statistical application SPSS23.0 software was used to analyze the differences in the prognostic scores of the three surgical methods in the two groups.The measurement data are presented as "x± s",and the test method is non-parametric test: the comparison between multiple groups is carried out by the Kruskal-Wallis H test method,and then the post hoc test is performed.The test standard p is 0.05.Results: In this study,45 patients(75%)had symptoms relieved one week after the operation of the 60 patients.Among the 12 patients with PFD,9 patients had improved symptoms and 3 patients had no obvious relief of symptoms.Among 17 patients with PFDD,13 patients had improved symptoms and symptoms.There was no significant relief in 4 cases;30 patients with cerebellar tonsillectomy had relief of symptoms,and 2cases had no significant relief.In terms of complications,5 out of 60 patients had dizziness and headache that cannot be tolerated now,including 3 cases in group B,2cases in group C,and one case in group C had a central nervous system infection after surgery.In the long-term follow-up,49 cases had a good prognosis.Among them,one case in group A relapsed(8.3%),and five cases in group B and C each had a poor prognosis(29%,15%).Among them,one case in group B had deterioration one year after surgery.The syringomyelia underwent cavity-abdominal shunt again.Three groups have no distinct difference about prognosis(P>0.05).In low-standard-group cases,the three surgical methods had no difference in prognosis(P>0.05).In high-standard-group cases,those who underwent cerebellar tonsillectomy(average prognostic score 8.35±1.15 points)were better than PFDD(average prognostic score7.5±0.97 points)(P<0.05).Conclusion: For the treatment of ChiariⅠmalformation,the three surgical methods have certain curative effects,and there is no significant difference in prognosis.However,after the preoperative scoring standard is used to adjust the grouping,the prognosis of the low group three types of surgery is not significantly different,however,the high group performs cerebellar tonsillectomy have a better outcome than PFDD significantly.Therefore,for patients with a score less than 6 points,especially those without syringomyelia,PFD may be a better appoarch,whereas for patients with a score greater than 6 and a significant herniation of the cerebellar tonsils,a microscopic cerebellar tonsillectomy with decompression may have a better prognosis.In short,the preoperative scoring standard has certain reference value for the determine of ChiariⅠdeformity surgery.