本文選題：Arnold-Chiari畸形　切入點(diǎn)：脊髓空洞癥　出處：《四川醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:使用磁共振(Magnetic Resonance Imaging,MRI)相位對(duì)比電影成像技術(shù)(cine PC)探討枕大池成形術(shù)(后顱窩減壓+小腦扁桃體切除+枕大池硬膜成形)對(duì)Chiari畸形Ⅰ型伴脊髓空洞癥患者腦脊液流體力學(xué)的影響,并評(píng)價(jià)手術(shù)療效。方法:選取臨床確診為Chiari畸形Ⅰ型伴脊髓空洞癥患者共40例,均行枕大池成形手術(shù)治療。采用Philips 3.0T超導(dǎo)型磁共振機(jī)相位對(duì)比電影序列對(duì)所有患者術(shù)前24h及術(shù)后12個(gè)月行腦脊液流體力學(xué)定性及定量檢測(cè)。層面選擇:①中腦導(dǎo)水管層面②腦橋腹側(cè)平面③頸3(C3)腹側(cè)平面。定量測(cè)量指標(biāo):①每搏輸出量:Stroke volume(SV)。②平均流量:Mean flux(MF)。③返流分?jǐn)?shù):Regurgitant Fraction(%)。④最大峰值流速:Peak velocity(Vmax)。⑤RR間期:RR Interval(ms)。統(tǒng)計(jì)分析其手術(shù)前后的變化,并對(duì)比手術(shù)前后患者JOA評(píng)分,評(píng)價(jià)手術(shù)療效。結(jié)果:術(shù)前定性觀察顯示腦脊液流動(dòng)呈與心臟舒縮相關(guān)的雙向流動(dòng),心臟收縮期腦脊液從頭側(cè)流向尾側(cè),舒張期腦脊液從尾側(cè)流向頭側(cè)。Chiari畸形Ⅰ型伴脊髓空洞癥患者枕骨大孔后緣空間阻塞嚴(yán)重,枕大池消失,腦脊液流動(dòng)信號(hào)幾乎消失,10例患者脊髓空洞內(nèi)液體與蛛網(wǎng)膜下腔腦脊液信號(hào)改變同步,證實(shí)空洞腔與脊髓蛛網(wǎng)膜下腔相通;術(shù)后沒有患者出現(xiàn)神經(jīng)功能惡化或死亡,PC-MRI掃描顯示枕大池成形良好,脊髓蛛網(wǎng)膜下腔通暢,枕骨大孔后緣腦脊液信號(hào)恢復(fù),30例患者脊髓空洞明顯縮小,8例患者脊髓空洞輕微縮小,2例患者脊髓空洞未見明顯變化;所有患者JOA評(píng)分增加,腦脊液每搏輸出量、平均流量增加,雙向最大峰值流速均減小,尤其C3層面更為明顯,差異比較均具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:枕大池成形術(shù)可以增加病變區(qū)腦脊液流量,減緩腦脊液峰值流速,減輕脊髓空洞,改善患者預(yù)后,是一種有效的術(shù)式。
[Abstract]:Objective: to investigate the effect of Cisternoplasty (posterior cranial fossa decompression and cerebellar tonsillectomy of occipital cistern dural formation) on patients with Chiari malformation type I with syringomyelia by using magnetic Resonance imaging phase contrast film imaging technique. The effect of hydrodynamics, Methods: 40 cases of syringomyelia with Chiari deformity type I were selected. All patients were treated with occipital cisternoplasty. Philips 3.0T superconducting magnetic resonance machine phase contrast film sequence was used to detect cerebrospinal fluid hydrodynamics qualitatively and quantitatively in all patients 24 hours before operation and 12 months after operation. The ventral plane of 2 pontine (3 neck 3) was measured quantitatively. The mean flow rate of 1: 1 stroke volume(SV).2 was 1: mean flux(MF).3 reflux fraction:: peak peak velocity of: peak velocity(Vmax).5RR interval: RR intervalmssis.The changes before and after operation were analyzed statistically, and the mean flow rate of 1: 1 stroke volume(SV).2 was measured before and after the operation, and the mean flow rate was: mean flux(MF).3 reflux fraction:% Regurgitant Fraction(%).4 maximal peak velocity: peak velocity(Vmax).5RR interval: RR intervalmsm. Results: before and after operation, cerebrospinal fluid flow showed a two-way flow associated with cardiac systolic and diastolic flow, and the contractile cerebrospinal fluid flowed from the head to the caudal side. Diastolic cerebrospinal fluid flowed from tail to head side. Chiari malformation type I with syringomyelia had severe obstruction of posterior margin of foramen magnum and disappeared of cistern magnum occipitalis. Cerebrospinal fluid flow signal almost disappeared in 10 patients with syringomyelia and subarachnoid cerebrospinal fluid signal changes synchronously, confirmed that the cavity and spinal subarachnoid cavity interlinked; PC-MRI scan showed that the cistern was well formed and the subarachnoid space of the spinal cord was unobstructed. Signal recovery of cerebrospinal fluid in posterior margin of occipital foramen in 30 patients with significant reduction of syringomyelia in 8 patients, slight reduction of syringomyelia in 8 patients and no significant change in syringomyelia in 2 patients, the JOA score of all patients was increased, and cerebrospinal fluid output per stroke was increased. With the increase of mean flow rate, the maximum flow velocity in both directions decreased, especially on C3 level. The difference was statistically significant (P 0.05). Conclusion: Cisteroplasty can increase the flow of cerebrospinal fluid and slow down the peak velocity of cerebrospinal fluid in the lesion area. Reducing syringomyelia and improving prognosis is an effective procedure.
【學(xué)位授予單位】：四川醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.1

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