脊柱肉状瘤病的外科治疗

Surgical management of vertebral sarcoidosis

目的:探讨脊柱肉状瘤病的临床特点、诊断依据和治疗方法。方法:回顾分析13例椎体肉状瘤病患者的临床资料,总结脊柱肉状瘤病的临床特点、诊断和治疗方法。结果:患者均以病变区域的疼痛起病并呈进行性加重,4例伴有神经损害症状。影像学检查示多个椎体骨质破坏,其他器官系统未发现病灶。因进行性加重的椎体破坏、脊柱不稳和/或神经症状均接受了前路病椎切除、自体髂骨植骨融合内固定术,术后予以类固醇激素治疗。围手术期没有严重并发症发生,术后病理诊断确诊为椎体肉状瘤病。随访时间12～52(中位数26)个月,患者随访期间临床症状完全缓解。视觉模拟评分(VAS)术前为7～10(中位数8)分,术后半年随访时降至0～4(中位数2)分。末次随访时均获得骨性融合,非手术病变部位的骨质呈硬化表现,无复发病例。结论:对于伴有进行性加重的脊柱不稳和/或神经症状的脊柱肉状瘤病患者,进行外科干预联合类固醇激素治疗,可获得良好的临床疗效。

Objective To investigate the clinical characteristics, diagnostic foundation and treatment of vertebral sarcoidosis. Methods The clinical data of 13 patients with vertebral sarcoidosis who received anterior debridement and instrumentation were retrospectively analyzed. Results The onset of progressive pain in the pathological region was common in the 13 patients. Neurologic deficit existed in 4 cases. Radiographic study showed multiple vertebral bone destructions, and no other systemic lesions were found. Surgical indications were progressive vertebral destruction, spinal instability or neurological deficit. Anterior vertebra resection, and autologous bone grafts fusion with internal fixation were done. No operative mortality and major complications occurred. Diagnosis was confirmed in all patients by pathological exam. After the surgery, metacortandracin treatment was given routinely for 1 year. Patients were followed up for 12-52 （median 26） months, and pain and neurological symptoms were alleviated. Visual analog scale （VAS） score was 7-10 （median 8） points preoperatively, which dropped to 0-4 （ median 2） points postoperatively. All patients showed successful bone fusion with no recurrence. Conclusion For vertebral sarcoidosis associated with progressive instability and/or neurological symptoms, surgical intervention combined with steroid therapy is safe and effective.