成人单椎体孤立性结核的诊断和治疗

Diagnosis and treatment of isolated vertebral body tuberculosis in adult

目的:探讨成人单椎体孤立性结核的临床特点及治疗方法。方法:2005年2月～2009年10月我院收治成人脊柱结核患者286例,其中单椎体结核患者6例,男4例,女2例;年龄20～38岁,平均26.2岁。均以腰痛为首发症状。病变均在腰椎,L11例,L22例,L32例,L41例。6例均行脊柱X线平片、CT扫描及MRI检查,X线平片上均无阳性发现;腰椎常规CT扫描2例发现椎体下缘孤立性囊性病灶,4例为轻度椎间盘突出;MRI检查均显示单椎体内圆形病灶,T1低信号、T2高信号改变,邻近椎间盘、附件信号正常,病变椎体轮廓及高度无异常。对病变椎体行CT扫描,可见椎体内为孤立性囊性溶骨性病灶,椎旁软组织未受累。2例术前未确诊,行病灶探查清除植骨术;4例结合临床诊断为单椎体结核,经抗结核治疗2～3周后行椎体内病灶清除、髂骨填塞植骨术。术后均行抗结核药物治疗8～10个月。结果:术后病理检查证实椎体病变均为结核改变。患者均获随访,随访时间1～4年,平均2年3个月,半年内血沉均恢复正常,腰痛症状逐渐消失,X线片证实植骨均愈合,平均骨融合时间为3.8个月。随访期间结核无复发。结论:成人单椎体孤立性结核临床较为少见,临床症状及影像学表现均不典型,CT和MRI联合检查可明确病灶的范围及骨破坏类型,规范抗结核药物治疗结合病灶清除椎体内植骨可取得良好疗效。

Objective：To investigate the clinical features and treatment of isolated vertebral body tuberculosis in adult.Method：From February 2005 to October 2009,286 patients with spinal tuberculosis underwent surgical treatment in our centre.Of these,isolated single vertebral body involvement due to tuberculosis was found in six adult patients （four males,two females;age range：20-38 years,mean 26.2 years）.Most cases presented with back pain as initial symptom.The tuberculosis lesion included L1 in 1 case,L2 in 2 cases,L3 in 2 cases and L4 in 1 case.All patients underwent plain radiography,computed tomography（CT） and magnetic resonance imaging （MRI）.Plain film showed normal profile and arrangement of lumber vertebra.The routine lumbar CT scan documented a single minimal cyst lesion in lower part of vertebral body in only 2 cases,and 4 cases had negative finding except of gentle lumber disc herniation.MRI showed solitary osteolytic lesion within vertebral body.Hypointense signal was seen on T1WI and hyperintense signal on T2WI was evidenced in the involved vertebra in all six patients on MRI.The disc space,posterior elements,and paravertebral soft tissues were not involved.A solitary osteolytic lesion within vertebral body with normal paravertebral soft tissue mass was showed on diseased vertebra′s CT scan.The initial 2 patients were admitted for operative exploration, whereas the remaining 4 patients were admitted for debridement through anterior or posterior approach after diagnosis was confirmed by clinical and imaging finding and after routine antitubercular chemotherapy for 2-3 weeks.A routine antitubercular chenotherapy lasted for 8-10 months after operation.Result：The histology revealed tuberculous in all cases.Six patients were followed up for an average of 2.3 years （ranged,1-4 years）. All cases got back pain relief within 6 months after operation.All patients had bony fusion in 3-4.5 months （average,3.8 months）.There was no recurrence of tuberculosis at follow-up.Conclusion：The isolated vertebral body tuberculosis in adult is rare clinically,which presents with atypical clinical presentations and imaging features.Combined use of CT and MRI can well demonstrate location and distribution of this lesion.Routine antitubercular chemotherapy and surgical debridement combined with bony graft can satisfactorily solve this.