两种手术方式对Chiari畸形Ⅰ型合并脊髓空洞的系统评价及meta分析

目的 系统评价后颅窝减压（posterior fossa decompression，PFD）和后颅窝减压加硬膜成形术（posterior fossa decompression plus duraplasty，PFDD）在Chiari畸形Ⅰ型合并脊髓空洞患者中的有效性及安全性。方法 检索Embase、Cochrane、Pubmed、Ovid、Medline、ScienceDirect、谷歌学术、万方、知网等数据库自建库到2019年的文献，筛选文中对PFD与PFDD进行了比较的随机对照研究或非随机对照研究，统计术后临床症状和影像学改善情况、并发症等指标，运用Revman（5.3版本）进行数据分析。结果 最终纳入10篇文献，共3 188例，PFDD组1 383例，PFD组1 805例。在脊髓空洞改善率（OR：5.53；95%CI：2.86，10.69）、症状缓解率（OR：2.53；95%CI：1.30，4.91）、并发症发生率（OR：3.46；95%CI：1.40，8.59）、脑脊液漏发生率（OR：9.36；95%CI：2.63，33.34）、假性硬脑膜膨出率（OR：1.89；95%CI：1.28，2.79）方面PFDD组高于PFD组（P<0.05）。在切口感染发生率（OR：1.44；95%CI：0.57，3.59）、皮下积液发生率（OR：1.71；95%CI：0.50，5.80）方面两种术式无差异（P>0.05）。结论 针对Chiari畸形Ⅰ型合并脊髓空洞的患者，PFDD的有效性优于PFD。

A systematic review and meta-analysis of two surgical approaches in patients with Chiari malformation type I with syringomyelia

Objective To conduct a systematic review of the efficacy and safety of posterior fossa decompression (PFD) and posterior fossa decompression plus duraplasty (PFDD) in patients with Chiari malformation type I with syringomyelia.Methods Articles published up to 2019 were collected from databases such as Embase, Cochrane, PubMed, Ovid, Medline, ScienceDirect, Google Scholar, Wanfang Data, and CNKI; the articles were screened for randomized controlled or non-randomized controlled studies which were conducted to compare PFD and PFDD. Postoperative clinical symptoms, radiological improvements, and complications were summarized, and data analysis was performed using Revman (version 5.3).Results A total of 10 articles were included in the study, including 3188 cases, which consisted of 1383 cases in the PFDD group and 1805 cases in the PFD group. Compared with the PFD group, the PFDD group had significantly higher rate of improvement in syringomyelia (odds ratioOR]:5.53, 95% confidence intervalCI]:2.86-10.69), symptom remission rate (OR:2.53, 95% CI:1.30-4.91), complication rate (OR:3.46, 95% CI:1.40-8.59), cerebrospinal fluid leak incidence rate (OR:9.36, 95% CI:2.63-33.34), and pseudomeningocele rate (OR:1.89, 95% CI:1.28-2.79) (all P<0.05). There were no significant differences between the two surgical approaches in the incidence rates of incision infection (OR:1.44, 95% CI:0.57-3.59) and subcutaneous hydrops (OR:1.71, 95% CI:0.50-5.80) (P>0.05).Conclusions PFDD is more effective than PFD in patients with Chiari malformation type I with syringomyelia.