后颅窝减压并植骨融合内固定术治疗复杂Chiari畸形

目的 探讨后颅窝减压并植骨融合内固定术治疗复杂Chiari畸形的效果。方法 2010年2月至2014年11月收治复杂Chiari 畸形17例，均采用后颅窝减压并植骨融合内固定术治疗，术中均行颅骨牵引+后路窝小骨窗减压植骨融合并内固定。结果 复位成功5例，未打开硬脊膜；复位不成功12例，行枕大池重建。术后出现颅内感染1例、切口感染伴脑脊液漏1例。术后5 d因呼吸衰竭死亡1例，其余16例术后随访3个月~3.5年，采用Tator等方法评价术后效果，16例均有效，有效率为94.1%（16/17）。结论 对复杂Chiari畸形，术前需明确诊断畸形的种类和性质，术中麻醉下牵引辅助治疗很有必要，后颅窝小骨窗减压并植骨融合并内固定是治疗复杂Chiari畸形的一种有效方法。

Treatment of complicated Chiari malformation by posterior fossa decompression combined with the bone graft fusion and the internal fixation

Objective To explore the surgical method to treat the complicated Chiari malformation (CCM) and its effect. Method Seventeen patients with CCM were treated by the posterior fossa decompression through the small skull window combined with the bone graft fusion and the internal fixation after the intraoperative skull traction. Results The successful reduction was reached by the skull traction without opening the spinal dura mater in 5 patients. The cisternae magnae were reconstructed in 12 patients in whom the reduction was unsuccessfully reached by the skull traction. The postoperative intracranial infection occurred in 1 patient and the postoperative infection of the wound associated with cerebrospinal leak occurred in 1 patient. One patient died from the respiratory failure 5 days after the surgery. Of 17 patients who were followed up for 3 months to 3.5 years, 16 were recovered well and 1 died. Conclusions The definite diagnosis should be made and the characters and types of the malformation should be cleared before the operation in the patients with CCM. The skull traction during the operation is necessary for the reduction after the anesthesia. The posterior fossa decompression of the small skull window combined with the bone graft fusion and the internal fixation is an effective method to treat CCM.