脊柱包虫病的诊断与治疗

Diagnosis and treatment of spinal hydatid disease

目的:探讨脊柱包虫病的诊断及治疗方法。方法:1990年10月～2010年10月手术治疗脊柱包虫病患者9例,病程为3个月～12年。临床表现为午后低热、腰背疼痛和腰背部包块,术前脊髓神经功能Frankel分级A级1例,B级2例,C级2例,D级4例。包虫病8项免疫试验均为阳性。术前均行影像学检查,病变单纯累及胸椎2例(T8、T9 1例,T11、T12 1例),腰椎2例(L3 1例,L1、L2、L3 1例),胸腰段4例(T12、L1 2例,T12、L1、L2 2例),骶椎1例。X线片、CT检查误诊为椎体结核5例、转移瘤2例、脊索瘤1例、腰大肌脓肿1例。MRI检查7例诊断为脊柱包虫病;2例病变单纯累及腰椎者缺乏囊中囊典型信号改变,误诊为脊柱转移瘤。均行椎管减压病灶清除植骨内固定术,其中病变单纯累及胸椎的2例与骶骨1例行后路全椎板切除减压,2例腰椎病变者行椎板间开窗椎管减压,4例胸腰段病变者行脊柱侧前方入路经横突椎管减压。7例术前诊断脊柱包虫病者术前口服抗包虫药阿苯达唑2～3周,所有患者术后继续服用阿苯达唑3个月。结果:手术时间210～330min,平均260min;术中失血量170～470ml,平均300ml。7例术前MRI检查诊断为脊柱包虫病者术后病理诊断为脊柱细粒棘球蚴病,2例术前MRI误诊为脊柱转移瘤者术后病理诊断为腰椎泡状棘球蚴病。随访1～10年,平均4.6年。1例腰椎泡状棘球蚴病患者术后8个月植骨未愈合,经理疗、促骨生长药物治疗,1年后复查X线片显示骨性愈合;其余8例患者植骨区骨性融合,愈合时间为5～8.5个月,平均7个月。末次随访患者脊髓神经功能Frankel分级改善6例,无变化3例。随访期间无复发。结论:MRI检查对脊柱细粒棘球蚴病有诊断价值,对腰椎泡状棘球蚴病易误诊,后者的确诊有赖于病理检查;脊柱包虫病在药物治疗的基础上采用手术治疗可取得较好疗效。

Objetives： To investigate the diagnosis and treatment of spinal hydatid disease. Methods： 9 cases suffering from spinal hydatid disease treated surgically from October 1990 to October 2010 were reviewed retrospectively. The natural history of spinal hydatid disease ranged from 3 months to 12 years. 9 cases pre- sented with fever, back pain and mass formation. Preoperative Frankel grade showed 1 grade A, 2 grade B, 2 grade C and 4 grade D. Hydatid 8 tests were positive for all cases. The lesion located at thoracic vertebrae in 2（T8, T9 in 1; Tll, T12 in 1）, lumbar vertebrae in 2（L3 in 1; L1, L2, L3 in 1）, thoracic waist in 4（T12, L1 in 2; T12, L1, L2 in 2）,and sacrum in 1. CT images showedbone hydatid similar to tuberculosis in 5 cases, metastases in 2, chordoblastoma in 1, psoas abscess in 1. 7 cases were determined as spinal hydatid disease by MRI, while 2 cases were diagnosed as spinal metastasis due to deficiency of typical findings of MRI. All cases underwent debridement, bony graft or bone cement filling and instrumentation. 2 cases with defect in thoracic and 1 in sacrum underwent posterior decompression and laminectomy. 4 cases with defect in thoracic underwent anterolateral approach. Albendazole was administrated for 2-3 weeks preoperatively and 3 months after operation. Results： The average surgical time was 260rain（range, 210-330min）, with the aver- age intraoperative blood loss of 300ml（range, 170-470ml）. 7 cases determined as spinal hydatid disease by preoperative MRI were diagnosed as spinal echinococcosis disease by pathologic test after operation, and 2 cases similar to spinal metastasis in preoperative MRI were diagnosed as alveolar echinococcosis disease. 9 cases were followed up for an average of 4.6 years（range, 1 to 10 years）. 1 case suffering from nonunion and diagnosed as alveolar echinococcosis achieved complete bony fusion at a mean of 1 years by responsive man- agement. 6 cases had Frankel grade improving at final follow-up, while 3 cases remained unchanged. No re- currence was noted in all cases during follow-up. Conclusions： Spinal echinococcosis disease can be determined by MRI, while for lumbar vertebral alveolar echinococcosis disease, MRI is easy to induce misdiagnosis, and its determination is relied on pathology. For the spinal hydatid disease, both drug and Surgery treatment could achieve better results.