寰枢椎内固定融合联合异位小脑扁桃体切除在Chiari畸形中的应用

目的探讨寰枢椎内固定联合异位小脑扁桃体切除术疗效，为临床诊疗提供新的诊疗思路。方法回顾性分析13例Chiari畸形患者的临床资料，所有患者均行“寰枢椎内固定术联合异位小脑扁桃体切除术”。通过对比术后1、3、6、12、18个月症状改善程度、JOA评分及影像学变化进行评估。结果所有患者症状均明显改善。JOA评分治愈1例，显效11例，有效2例，无效0例。影像学上脑干腹侧及枕大池脑脊液通畅。结论后颅窝小骨窗减压，下疝的部分小脑扁桃体切除，同时行寰枢椎内固定融合术，兼顾寰枢椎不稳的病因和局部受压、脑脊液循环障碍所引起症状，即对因、对症治疗，临床效果满意，随访期间无复发、症状加重病例，为治疗Chiari畸形提供了新思路。

Objective To explore the effect of atlantoaxial internal fixation combined with ectopic cerebellar tonsillectomy, so as to provide new ideas for clinical diagnosis and treatment. Methods The clinical data of 13 patients with Chiari malformation were analyzed retrospectively. All patients underwent “atlantoaxial internal fixation combined with ectopic cerebellar tonsillectomy”. The improvement of symptoms, JOA score and imaging changes at 1, 3, 6, 12 and 18 months after operation were evaluated. Results The symptoms of all patients were significantly improved. JOA score showed 1 was cured, 11 markedly effective, 2 effective and 0 ineffective. On imaging, the cerebrospinal fluid of ventral brainstem and occipital cistern was unobstructed. Conclusions Decompression of the small bone window of the posterior cranial fossa, partial resection of the cerebellar tonsils of the lower hernia, and atlantoaxial internal fixation and fusion are performed at the same time, taking into account the etiology of atlantoaxial instability and the symptoms caused by local compression and cerebrospinal fluid circulation disorder, that is symptomatic treatment. The clinical effect is satisfactory, and there are no cases of recurrence and aggravation of symptoms during the follow-up, which provides a new idea for the treatment of Chiari malformation.