發(fā)布時(shí)間：2017-12-27 11:02

  本文關(guān)鍵詞：小腦扁桃體下疝Ⅰ型術(shù)后枕骨大孔區(qū)腦脊液變化與預(yù)后相關(guān)性分析　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： Chiari Ⅰ畸形 平均流量 磁共振相位對比技術(shù) 去骨瓣減壓術(shù) 平均流速

【摘要】：目的:去骨瓣減壓術(shù)是治療小腦扁桃體下疝Ⅰ型侵襲性最小的手術(shù),可以避免入侵硬膜帶來的并發(fā)癥。手術(shù)的目的是為了改善腦脊液循環(huán),緩解枕骨大孔區(qū)梗阻。手術(shù)前后應(yīng)用磁共振相位對比技術(shù)對CM-Ⅰ患者枕骨大孔區(qū)腦脊液流動進(jìn)行定量測定,并隨訪獲得預(yù)后資料。進(jìn)而對手術(shù)前后枕骨大孔區(qū)腦脊液流體力學(xué)的變化和治療效果進(jìn)行相關(guān)性分析。方法:所有的患者都進(jìn)行術(shù)前資料采集,包括病史、體征檢查、傳統(tǒng)的基礎(chǔ)頭部及脊椎MRI,并用PC-MRI記錄患者術(shù)前術(shù)后顱內(nèi)感興趣區(qū)腦脊液流動的相關(guān)參數(shù),檢查時(shí)采用仰臥位,檢查序列有頭部T1及T2加權(quán)相,PC(正中矢狀位及枕骨大孔平面的軸位相)。獲得枕骨大孔處腦脊液流量的數(shù)據(jù)。于術(shù)后7天,3個(gè)月,6個(gè)月對患者進(jìn)行隨訪,記錄患者CCOS評分,評價(jià)預(yù)后效果。并與腦脊液流動的相關(guān)參數(shù)進(jìn)行性慣性分析。結(jié)果:13例患者中9例患者(69%)合并脊髓空洞癥,脊髓空洞長度8.52到24.16cm(平均15.16cm)。13例患者中術(shù)后枕骨大孔處腦脊液平均流量最小0.589ml/s,最大平均流量6.734ml/s,平均2.840ml/s,術(shù)后平均增加1.056ml/s�；颊哒砉谴罂滋幠X脊液的平均流速在術(shù)前及術(shù)后沒有明顯的統(tǒng)計(jì)學(xué)差異(P0.05)�；颊哒砉谴罂滋幠X脊液的平均流量在術(shù)前及術(shù)后有明顯的統(tǒng)計(jì)學(xué)差異(P=0.08)。而且腦脊液的變化與患者的預(yù)后評分(CCOS評分)具有相關(guān)性,并且呈正相關(guān)(P=0.027,R=0.608)。同時(shí),在本研究中,小腦扁桃體疝出的距離和脊髓空洞的長度在統(tǒng)計(jì)學(xué)上不具有相關(guān)性(P0.05)。結(jié)論:對我院15-16年所有行去骨瓣減壓并留有PC-MRI數(shù)據(jù)的13例患者進(jìn)行研究發(fā)現(xiàn),枕骨大孔區(qū)術(shù)前和術(shù)后的CSF流量的變化程度與患者預(yù)后的程度有相關(guān)性,并且成正相關(guān)(P=0.0270,R=0.608),即枕骨大孔區(qū)腦脊液的平均流量在手術(shù)之后增加的越多,患者的預(yù)后越好。在本研究中,小腦扁桃體疝出的距離和脊髓空洞的長度在統(tǒng)計(jì)學(xué)上不具有相關(guān)性(P0.05),即小腦扁桃體疝出的距離和脊髓空洞的長度不相關(guān)。
[Abstract]:Objective: decompression of bone flap is the least invasive procedure for the treatment of type I of cerebellar tonsillar hernia, and it can avoid the complications of intradural invasion. The purpose of the operation is to improve the circulation of the cerebrospinal fluid and alleviate the obstruction of the occipital foramen area. The cerebrospinal fluid flow in the occipital foramen area of CM- I was quantified and the prognosis was followed up before and after the operation. The changes of cerebrospinal fluid dynamics and the therapeutic effect of the cerebrospinal fluid in the occipital foramen area before and after the operation were analyzed. Methods: all patients underwent preoperative data acquisition, including the basis of head and spine MRI medical history, physical examination, the related parameters and PC-MRI were recorded before and after surgery of intracranial cerebrospinal fluid flow in the region of interest, check the supine position, check the sequence of head T1 and T2 weighted phase, PC (shaft phase sagittal plane and the foramen magnum). The data of the cerebrospinal fluid flow at the occipital foramen were obtained. The patients were followed up at 7 days, 3 months and 6 months after the operation. The patients' CCOS score was recorded and the prognosis was evaluated. The parameters of the cerebrospinal fluid flow were analyzed. Results: 13 patients in 9 patients (69%) with syringomyelia, syringomyelia length of 8.52 to 24.16cm (average 15.16cm). The average flow rate of cerebrospinal fluid in the occipital foramen was least 0.589ml/s, the maximum average flow rate was 6.734ml/s, the average 2.840ml/s, and the average increase of 1.056ml/s after operation in 13 cases. The mean velocity of cerebrospinal fluid in the occipital foramen was not significantly different between the patients before and after the operation (P0.05). The mean flow of cerebrospinal fluid in the occipital foramen was significantly different between the patients before and after the operation (P=0.08). The changes in cerebrospinal fluid were correlated with the patient's prognosis score (CCOS score) and had a positive correlation (P=0.027, R=0.608). At the same time, in this study, the distance from the cerebellar tonsil hernia and the length of the cavities of the spinal cord were not statistically significant (P0.05). Conclusion: in our hospital during 15-16 all decompressive craniectomy and have found 13 cases of PC-MRI patients with CSF correlation data, the flow of the foramen magnum preoperative and postoperative change degree and the prognosis of patients, and positive correlation (P=0.0270, R=0.608), the average flow is pillow of cerebrospinal fluid bone Foramen after surgery increased more, the better the prognosis of patients. In this study, the distance between the herniation of cerebellar tonsil and the length of syringomyelia was not statistically correlated (P0.05), that is, the distance between cerebellar tonsil hernia and the length of syringomyelia is not related.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.1

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