KEYPOINT<\/p>\n
1.\u4ecb\u7ecd\u4e86\u5bf0\u67a2\u690e\u8131\u4f4d\u3001\u9885\u5e95\u51f9\u9677\u75c7\u548cChiari\u7578\u5f62\u7684\u8bca\u65ad\u548c\u6cbb\u7597\u3001\u533a\u522b\u548c\u8054\u7cfb\u3002<\/p>\n<\/p>\n
\u5bf0\u67a2\u690e\u8131\u4f4d\u3001\u9885\u5e95\u51f9\u9677\u75c7\u548cChiari\u7578\u5f62\u662f\u9885\u9888\u4ea4\u754c\u533a\u5e38\u89c1\u7684\u4e09\u4e2a\u8bca\u65ad\uff0c\u4e5f\u5904\u4e8e\u810a\u67f1\u5916\u79d1\u548c\u795e\u7ecf\u5916\u79d1\u7684\u4ea4\u53c9\u533a\u57df\u3002\u4e09\u4e2a\u8bca\u65ad\u53ef\u5355\u72ec\u51fa\u73b0\uff0c\u4e5f\u7ecf\u5e38\u7ec4\u5408\u51fa\u73b0\uff0c\u52a0\u4e4b\u4e0d\u540c\u7684\u5206\u578b\uff0c\u6709\u65f6\u5019\u5bb9\u6613\u641e\u7cca\u6d82\u3002\u4e0b\u9762\u901a\u8fc7\u4e09\u7bc7\u7efc\u8ff0\uff0c\u7ed3\u5408\u7c97\u6d45\u7684\u7406\u89e3\uff0c\u5bf9\u4e09\u4e2a\u75be\u75c5\u7684\u8bca\u65ad\u8981\u70b9\u3001\u6cbb\u7597\u7b56\u7565\u3001\u533a\u522b\u548c\u8054\u7cfb\u505a\u4e00\u7b80\u8ff0\u3002<\/p>\n
1\u5bf0\u67a2\u690e\u8131\u4f4d<\/p>\n
1.1\u8bca\u65ad\u4f9d\u636e<\/p>\n
\u3000\u3000\u5bf0\u67a2\u690e\u8131\u4f4d\u6307\u5bf0\u9f7f\u524d\u95f4\u9699\u589e\u5927\uff0c\u524d\u5c48\u4f4d\u9888\u690eX\u7ebf\u4e0a\u6210\u4eba>3mm\u3001\u513f\u7ae5>5mm\u53ef\u8bca\u65ad\u5bf0\u67a2\u690e\u8131\u4f4d\u3002<\/p>\n
\u3000\u3000\u4e3b\u8981\u7531\u521b\u4f24\u6027\uff08\u4e0a\u9888\u690e\u9aa8\u6298\u7b49\uff09\u3001\u9057\u4f20\u6027\uff08\u5510\u6c0f\u7efc\u5408\u5f81\u7b49\uff09\u3001\u708e\u75c7\u6027\uff08\u7c7b\u98ce\u6e7f\u6027\u5173\u8282\u708e\u7b49\uff09\u7b49\u8bf8\u591a\u75c5\u7406\u56e0\u7d20\u5bfc\u81f4\u3002<\/p>\n<\/p>\n
1.2\u4e34\u5e8a\u8868\u73b0<\/p>\n
\u3000\u3000\u4e34\u5e8a\u8868\u73b0\u975e\u5e38\u591a\u6837\uff0c\u8f7b\u5fae\u9888\u90e8\u75bc\u75db\u3001\u9ad8\u4f4d\u9888\u810a\u9ad3\u75c5\u3001\u4f4e\u4f4d\u9885\u795e\u7ecf\u75c5\u5747\u53ef\u8868\u73b0\u3002\u4e0a\u56fe\u4e2dSAC\u4e3a\u5bf0\u67a2\u690e\u7ba1\u50a8\u5907\u95f4\u9699\uff0c\u6d4b\u91cf\u7684\u662f\u5bf0\u9f7f\u540e\u95f4\u9699\u3002SAC<13mm\u5f80\u5f80\u51fa\u73b0\u795e\u7ecf\u53d7\u538b\u75c7\u72b6\u3002<\/p>\n
1.3\u5206\u578b<\/p>\n
\u3000\u30002013\u5e74\u738b\u8d85\u5206\u578b\u662f\u5e94\u7528\u6700\u5e7f\u6cdb\u3001\u6700\u5177\u6709\u6307\u5bfc\u4ef7\u503c\u7684\u5206\u578b\u3002I\u578b\u4e3a\u8fc7\u4f38\u4f4dX\u7ebf\u53ef\u590d\u4f4d\u3001II\u578b\u4e3a\u9ebb\u9189\u540e\u7275\u5f15\u53ef\u590d\u4f4d\uff0cIII\u578b\u4e3a\u9ebb\u9189\u540e\u7275\u5f15\u4ecd\u4e0d\u53ef\u590d\u4f4d\uff0cIV\u578b\u4e3aCT\u4e0a\u663e\u793a\u5bf0\u67a2\u5173\u8282\u9aa8\u6027\u878d\u5408\u3002<\/p>\n
1.4\u6cbb\u7597\u7b56\u7565<\/p>\n
\u3000\u3000\u8bca\u65ad\u660e\u786e\u7684\u5bf0\u67a2\u690e\u8131\u4f4d\u5747\u5e94\u624b\u672f\u6cbb\u7597\uff0c\u624b\u672f\u662f\u590d\u4f4d\u5bf0\u67a2\u5173\u8282\u4f4d\u7f6e\u5173\u7cfb\uff0c\u5bf0\u67a2\/\u6795\u9888\u56fa\u5b9a\u3001\u690d\u9aa8\u878d\u5408\uff0c\u5373\u590d\u4f4d\u56fa\u5b9a\u878d\u5408\u3002<\/p>\n<\/p>\n
2<\/p>\n
\u9885\u5e95\u51f9\u9677\u75c7<\/p>\n
2.1\u8bca\u65ad\u4f9d\u636e<\/p>\n
\u3000\u3000\u9885\u5e95\u51f9\u9677\u75c7\u662f\u9f7f\u72b6\u7a81\u9ad8\u51fa\u6b63\u5e38\u6c34\u5e73\u8fdb\u5165\u6795\u9aa8\u5927\u5b54\u5185\u3002\u53ef\u5b58\u5728\u5148\u5929\u56e0\u7d20\uff0c\u5728\u5934\u90e8\u91cd\u91cf\u548c\u9888\u90e8\u808c\u8089\u7275\u62c9\u4f5c\u7528\u4e0b\u9010\u6e10\u51fa\u73b0\u75c7\u72b6\u3002\u901a\u8fc7X\u7ebf\u6216CT\u4e0a3\u6761\u7ebf\u8fdb\u884c\u786e\u8bca\u3002<\/p>\n
\u3000\u3000McRae\u7ebf\uff1a\u6795\u9aa8\u5927\u5b54\u524d\u7f18\u548c\u540e\u7f18\u4e4b\u524d\u7684\u8fde\u7ebf\uff0c\u9f7f\u72b6\u7a81\u8d85\u8fc7\u6b64\u7ebf\u53ef\u8bca\u65ad\u3002<\/p>\n
\u3000\u3000Chamberlain\u7ebf\uff1a\u786c\u816d\u540e\u7f18\u5230\u6795\u9aa8\u5927\u5b54\u540e\u7f18\u8fde\u7ebf\uff0c\u9f7f\u72b6\u7a81\u8d85\u8fc7\u6b21\u7ebf>5mm\u53ef\u8bca\u65ad\u3002<\/p>\n
\u3000\u3000McGregor\u7ebf\uff1a\u786c\u816d\u540e\u7f18\u4e0e\u9885\u9aa8\u9cde\u90e8\u6700\u4f4e\u70b9\u7684\u8fde\u7ebf\uff0c\u9f7f\u72b6\u7a81\u8d85\u8fc7\u6b21\u7ebf>7mm\u53ef\u8bca\u65ad\uff0c\u4fbf\u4e8e\u5728X\u7ebf\u4e0a\u89c2\u5bdf\uff0c<\/p>\n
2.1\u4e34\u5e8a\u8868\u73b0<\/p>\n
\u3000\u3000\u8f7b\u5fae\u9888\u90e8\u75bc\u75db\u3001\u9ad8\u4f4d\u9888\u810a\u9ad3\u75c5\u3001\u4f4e\u4f4d\u9885\u795e\u7ecf\u75c5\u5747\u53ef\u8868\u73b0\u3002\u9888\u90e8\u5c40\u90e8\u53ef\u53d1\u73b0\u77ed\u9888\u548c\u4f4e\u53d1\u9645\u7ebf\u3002<\/p>\n
2.3\u5206\u578b\u548c\u6cbb\u7597\u7b56\u7565<\/p>\n
\u3000\u3000Goel\u5c06\u9885\u5e95\u51f9\u9677\u75c7\u5206\u4e3aA\u3001B\u4e24\u578b\u3002A\u578b\uff1a\u4f34\u5bf0\u67a2\u690e\u8131\u4f4d\uff0cB\u578b\uff1a\u4e0d\u4f34\u5bf0\u67a2\u690e\u8131\u4f4d<\/p>\n
\u3000\u3000B\u578b\u9885\u5e95\u51f9\u9677\u75c7\u5f80\u5f80\u6ca1\u6709\u795e\u7ecf\u75c7\u72b6\uff0cA\u578b\u9885\u5e95\u51f9\u9677\u75c7\u8bca\u65ad\u660e\u786e\u5747\u9700\u624b\u672f\u6cbb\u7597\u3002<\/p>\n
\u3000\u3000\u624b\u672f\u6cbb\u7597\u7684\u76ee\u6807\u662f\u9f7f\u72b6\u7a81\u4e0b\u964d\u81f3\u6b63\u5e38\u4f4d\u7f6e\u3001\u5bf0\u9f7f\u524d\u95f4\u9699\u95ed\u5408\u3001\u659c\u5761\u67a2\u690e\u89d2\u589e\u5927\u3002<\/p>\n
\u3000\u3000\u5e38\u7528\u624b\u672f\u65b9\u5f0f\u4e3a\u6795\u9888\u56fa\u5b9a\u878d\u5408\uff0c\u5fc5\u8981\u65f6\u9700\u7ecf\u524d\u8def\u8fdb\u884c\u5bf0\u67a2\u4fa7\u5757\u677e\u89e3\u3002<\/p>\n<\/p>\n
3<\/p>\n
Chiari\u7578\u5f62<\/p>\n
3.1\u8bca\u65ad\u4f9d\u636e<\/p>\n
\u3000\u3000Chiari\u7578\u5f62\u53c8\u53eb\u5c0f\u8111\u6241\u6843\u4f53\u4e0b\u759d\uff0c\u5373MRI\u4e0a\u5c0f\u8111\u6241\u6843\u4f53\u901a\u8fc7\u6795\u9aa8\u5927\u5b54\u5411\u4e0b\u79fb\u4f4d\uff0c\u8d8a\u6765\u8d8a\u591a\u5b66\u8005\u8ba4\u4e3a\u5e94\u8be5\u53ebChiari\u5f02\u5e38\u3002<\/p>\n<\/p>\n
3.2\u4e34\u5e8a\u8868\u73b0\u548c\u5206\u578b<\/p>\n
\u3000\u3000\u5c0f\u8111\u6241\u6843\u4f53\u4e0b\u7f18\u8d85\u8fc7\u6795\u9aa8\u5927\u5b54\u8fde\u7ebf5mm\uff0c\u6216\u8d85\u8fc73mm\u4f34\u660e\u663e\u75c7\u72b6\u3002\u4e34\u5e8a\u8868\u73b0\u4e3a\u4e0e\u6897\u963b\u6027\u8111\u79ef\u6c34\u3001\u773c\u7403\u8fd0\u52a8\u5f02\u5e38\u3001\u5c0f\u8111\u7f3a\u9677\u6709\u5173\uff0c\u75bc\u75db\u6216\u5934\u75bc\u662f\u5e38\u89c1\u8868\u73b0\u3002\u5e38\u5408\u5e76\u810a\u9ad3\u7a7a\u6d1e\u3002<\/p>\n
\u3000\u3000\u5206\u4e3a3\u578b\uff0cI\u578b\u6700\u5e38\u89c1\uff0c\u4e3a\u9752\u5c11\u5e74\u6216\u6210\u4eba\u4e00\u4fa7\u6216\u4e24\u4fa7\u5c0f\u8111\u6241\u6843\u4f53\u5411\u4e0b\u79fb\u4f4d\uff0cII\u578b\u4e3a\u80ce\u513f\u6216\u65b0\u751f\u513f\u5c0f\u8111\u8693\u90e8\u548c\u5ef6\u9ad3\u901a\u8fc7\u6795\u9aa8\u5927\u5b54\uff0cIII\u578b\u4e3a\u80ce\u513f\u6216\u65b0\u751f\u513f\u8111\u81a8\u51fa\uff0cII\u578b\u548cIII\u578b\u7f55\u89c1\u3002<\/p>\n
3.3\u6cbb\u7597\u7b56\u7565<\/p>\n
\u3000\u3000\u6cbb\u7597\u65b9\u5f0f\u4ee5\u624b\u672f\u51cf\u538b\u4e3a\u4e3b\uff0c\u76ee\u7684\u5728\u4e8e\u89e3\u9664\u540e\u8111\u548c\u810a\u9ad3\u53d7\u538b\uff0c\u7ea0\u6b63\u89e3\u5256\u7ed3\u6784\u5f02\u5e38\uff0c\u91cd\u5efa\u8111\u810a\u6db2\u5faa\u73af\u3002\u75c7\u72b6\u6539\u5584\u7387\u4e3a82.5%-84.5%\uff0c\u6539\u5584\u6700\u660e\u663e\u7684\u662f\u5934\u75db\uff0c\u5176\u6b21\u662f\u795e\u7ecf\u529f\u80fd\u3002<\/p>\n
4<\/p>\n
\u4e24\u4e2a\u76f8\u5173\u6982\u5ff5<\/p>\n
\u6241\u5e73\u9885\u5e95\u548c\u810a\u9ad3\u7a7a\u6d1e\u662f\u4e0a\u9888\u690e\u75be\u75c5\u4e2d\u5e38\u51fa\u73b0\u7684\u4e24\u4e2a\u6982\u5ff5\uff0c\u5728\u6b64\u4e00\u5e76\u4ecb\u7ecd\u3002<\/p>\n
4.1\u6241\u5e73\u9885\u5e95<\/p>\n
\u3000\u3000\u6241\u5e73\u9885\u5e95\u662f\u6307\u9f3b\u6839-\u8776\u978d\u4e2d\u5fc3-\u6795\u5927\u5b54\u524d\u7f18\u8fde\u7ebf\u7684\u5939\u89d2\uff08Welcher-Basal\u89d2\uff09>145\u00b0\uff0c\u9885\u5e95\u53d8\u5f97\u6241\u5e73\uff0c\u5bfc\u81f4\u540e\u9885\u7a9d\u7684\u5bb9\u79ef\u51cf\u5c11\u3002<\/p>\n<\/p>\n
4.2\u810a\u9ad3\u7a7a\u6d1e<\/p>\n
\u3000\u3000\u810a\u9ad3\u7a7a\u6d1e\u662f\u6307\u810a\u9ad3\u5185\u51fa\u73b0\u7ba1\u72b6\u56ca\u8154\uff0c\u5e38\u4e3a\u4e2d\u592e\u7ba1\u6269\u5f20\uff0c\u5176\u5185\u4e3a\u8111\u810a\u6db2\uff0c\u5e38\u4e3a\u5176\u5b83\u75be\u75c5\u5bfc\u81f4\u8111\u810a\u6db2\u5faa\u73af\u5f02\u5e38\u7684\u4f34\u968f\u8868\u73b0\u3002<\/p>\n<\/p>\n
5<\/p>\n
\u533a\u522b\u548c\u8054\u7cfb<\/p>\n
\u5bf0\u67a2\u690e\u8131\u4f4d\u5c31\u770b\u52a8\u529b\u4f4dX\u7ebf\u3001\u9885\u5e95\u51f9\u9677\u75c7\u5c31\u770bCT\u4e0a\u7684\u4e09\u6839\u7ebf\u3001Chiari\u7578\u5f62\u5c31\u770bMRI\u4e0a\u7684\u5c0f\u8111\u6241\u6843\u4f53\u4f4d\u7f6e\uff0c\u6293\u4f4f\u8bca\u65ad\u8981\u70b9\u5c31\u4e00\u76ee\u4e86\u7136\u4e86\u3002<\/p>\n
\u3000\u82e5\u5b58\u5728\u5bf0\u67a2\u690e\u8131\u4f4d\uff0c\u5176\u5e94\u4e3a\u7b2c\u4e00\u8bca\u65ad\uff0c\u53ef\u5408\u5e76\u9885\u5e95\u51f9\u9677\u75c7\u3001Chiari\u7578\u5f62\u548c\u810a\u9ad3\u7a7a\u6d1e\u3002\u4e3b\u8981\u662f\u810a\u67f1\u5916\u79d1\u533b\u751f\u6cbb\u7597\uff0c\u5176\u6d89\u53ca\u5bf0\u67a2\u4fa7\u5757\u5173\u8282\u3001\u5bf0\u9f7f\u5173\u8282\u7684\u5bf9\u4f4d\u5173\u7cfb\u5f02\u5e38\uff0c\u9700\u8981\u8fdb\u884c\u9aa8\u7ec4\u7ec7\u7684\u590d\u4f4d\u56fa\u5b9a\u878d\u5408\uff0c\u800c\u4e14\u590d\u4f4d\u7684\u540c\u65f6\u5373\u5b9e\u73b0\u4e86\u795e\u7ecf\u51cf\u538b\u3002<\/p>\n
\u3000\u9885\u5e95\u51f9\u9677\u75c7A\u578b\u76f4\u63a5\u5c31\u5408\u5e76\u5bf0\u67a2\u690e\u8131\u4f4d\uff0c\u4e5f\u5e38\u5408\u5e76Chiari\u7578\u5f62\u548c\u810a\u9ad3\u7a7a\u6d1e\u3002\u6cbb\u7597\u548c\u5bf0\u67a2\u690e\u8131\u4f4d\u4e00\u81f4\u3002<\/p>\n
\u3000\u9885\u5e95\u51f9\u9677\u75c7B\u578b\u82e5\u65e0\u75c7\u72b6\uff0c\u65e0\u9700\u5904\u7406\u3002\u6709\u75c7\u72b6\u7684B\u578b\u5f80\u5f80\u5408\u5e76Chiari\u7578\u5f62\u3002\u5e38\u89c4\u7684\u5904\u7406\u6309\u7167Chiari\u7578\u5f62\u884c\u624b\u672f\u51cf\u538b\uff0c\u800c\u4e0d\u7ea0\u6b63\u9885\u5e95\u51f9\u9677\u3002\u8fd1\u5e74\u6765\u4e00\u4e9b\u533b\u751f\u5728\u76f4\u63a5\u51cf\u538b\u7684\u540c\u65f6\u7ea0\u6b63\u9885\u5e95\u51f9\u9677\uff0c\u8fdb\u884c\u56fa\u5b9a\u878d\u5408\uff0c\u8ba4\u4e3a\u4e5f\u8bb8\u80fd\u6539\u5584\u6cbb\u7597\u6548\u679c\u3002\u8fd9\u4e00\u7406\u5ff5\u672a\u88ab\u5e7f\u6cdb\u63a5\u53d7\u3002<\/p>\n
\u3000\u5355\u7eafChiari\u7578\u5f62\u662f\u4e00\u4e2a\u5178\u578b\u7684\u795e\u7ecf\u5916\u79d1\u75be\u75c5\uff0c\u810a\u67f1\u5916\u79d1\u5f80\u5f80\u4e0d\u8fdb\u884c\u76f8\u5173\u624b\u672f\uff0c\u53ef\u8f6c\u79d1\u81f3\u795e\u7ecf\u5916\u79d1\u884c\u51cf\u538b\u624b\u672f\u3002\u8fd1\u5e74\u6765\u4e00\u4e9b\u533b\u751f\u5bf9\u4e0d\u5408\u5e76\u5bf0\u67a2\u690e\u8131\u4f4d\u7684\u5355\u7eafChiari\u7578\u5f62\u4ea6\u8fdb\u884c\u5bf0\u67a2\u690e\u56fa\u5b9a\u878d\u5408\uff0c\u5176\u7406\u7531\u662f\u53ef\u80fd\u5b58\u5728\u6f5c\u5728\u4e0d\u7a33\u5b9a\uff0c\u56fa\u5b9a\u878d\u5408\u4e5f\u8bb8\u80fd\u63d0\u9ad8\u6cbb\u7597\u6548\u679c\u3002\u8fd9\u4e00\u7406\u5ff5\u672a\u88ab\u5e7f\u6cdb\u63a5\u53d7\u3002<\/p>\n
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1.Yang SY,Boniello AJ,Poorman CE,Chang AL,Wang S,Passias PG.A review of the diagnosis and treatment of atlantoaxial dislocations.Global Spine J.2014 Aug;4(3):197-210.doi:10.1055\/s-0034-1376371.Epub 2014 May 22.PMID:25083363;PMCID:PMC4111952.<\/p>\n
2.Smith JS,Shaffrey CI,Abel MF,Menezes AH.Basilar invagination.Neurosurgery.2010 Mar;66(3 Suppl):39-47.doi:10.1227\/01.NEU.0000365770.10690.6F.PMID:20173526.<\/p>\n
3.Holly LT,Batzdorf U.Chiari malformation and syringomyelia.J Neurosurg Spine.2019 Nov 1;31(5):619-628.doi:10.3171\/2019.7.SPINE181139.PMID:31675698.<\/p>\n
4..Wang S,Wang C,Yan M,Zhou H,Dang G.Novel surgical classification and treatment strategy for atlantoaxial dislocations.Spine(Phila Pa 1976).2013 Oct 1;38(21):E1348-56.doi:10.1097\/BRS.0b013e3182a1e5e4.PMID:23823573.<\/p>\n","protected":false},"excerpt":{"rendered":"
KEYPOINT 1.\u4ecb\u7ecd\u4e86\u5bf0\u67a2\u690e\u8131\u4f4d\u3001\u9885\u5e95\u51f9\u9677\u75c7\u548cChiari\u7578\u5f62\u7684\u8bca\u65ad\u548c\u6cbb\u7597 … \u7ee7\u7eed\u9605\u8bfb