C型臂X线机引导经椎板穿刺生物蛋白胶注射术和开放手术治疗症状性骶管囊肿的疗效比较

Clinical results of C arm X-ray machine guided fibrin gel therapy versus open surgery in symptomatic sacral canal cysts

[目的]比较两种手术方法治疗症状性骶管囊肿的疗效。[方法]2003年6月～2011年4月,分别采用C型臂X线机引导下经椎板穿刺注射医用生物蛋白胶封闭囊肿术(蛋白胶注射组30例)及棘突切除、椎板开窗囊肿摘除术(囊肿摘除术组18例)治疗48例有临床症状的骶管囊肿患者,比较两组患者术前、术后腰骶部疼痛和功能改善情况。[结果]手术时间、术中出血量、住院时间、并发症,蛋白胶注射组均明显小于囊肿摘除术组(P<0.01)。蛋白胶注射组5例失访,囊肿摘除术组4例失访,总失访率18.8%。随访时间7～96个月,平均18.4个月。两组患者末次随访时VAS和ODI评分与术前比较有显著差异(P<0.01),蛋白胶注射组、囊肿摘除术组间VAS评分改善率比较差异有统计学意义(P<0.05),ODI评分改善率比较差异有显著统计学意义(P<0.01)。蛋白胶注射组患者疼痛改善时间及功能改善时间均较囊肿摘除术组患者早。根据分级标准,蛋白胶注射组疼痛改善优良率为88%,囊肿摘除术组为71%;蛋白胶注射组功能改善优良率为88%,囊肿摘除术组为71%。[结论]C型臂X线机引导下注射生物蛋白胶治疗骶管囊肿是一种有效的治疗方法,可免除开放手术的创伤痛苦,具有微创操作、安全、经济等优点。

[ Objective] To evalnte the clinical outcomes of two different surgical treatments for sacral canal cysts. [ Methotis] From June 2003 to April 2011,48 cases of sacral canal cysts were treated by trans -laminar fibrin gel injection under C arm X- ray machine guiding （fibrin gel injection group, 30 cases） and traditonal simple sacral laminectomies with resection of the cysts （cysts resection group, 18 cases） . Preoperative data and postoperative lumbosacral pain and function improvement were analyzed and compared between two groups. [ Results] The operative time, bleeding , length of stay and complications rate in fibrin gel injection group were significantly less than those in cysts resection group （P 〈 0. 01 ） . There were significant differences in visual analogue scale score and Oswestry functional disability index between preoperation and postoperation （ P 〈 0. 01 ）, in both groups. There was significant difference in the rate of function improvement between two groups （ P 〈 0. 05 ） but no significant difference in the rate of lumbosacral pain improvement （ P 〉 0. 05 ） . The improvement time of lumbosacral pain and function in fibrin gel injection group was shorter than that in cysts resection group. According to the rating scale, the excellent and good result rates of pain improvement were 88% in fibrin gel injection group and 71% in cysts resection group. The excellent and good result rates of function improvement were 88% in fibrin gel injection group and 71% in cysts resection group. [ Conclusion] C arm X -ray machine guided fibrin gel therapy for symptomatic sacral canal cysts is a simple, safe, repeatable and effective therapy.