椎管内炎性肉芽肿的诊断与手术治疗

Diagnosis and surgical treatment of spinal inflammatory granuloma

[目的]回顾性分析椎管内炎性肉芽肿的诊断策略、治疗方式选择及临床疗效。[方法]对入住本科的23例有神经系统症状及功能障碍的椎管内占位患者,术前详尽实验室及影像检查排除肿瘤、结核等相关性病变,明确手术指征,行手术病灶清除植骨融合内固定,术后病理学送检。以疼痛视觉模拟评分(VAS)、frankle脊髓损伤等级评分作为临床疗效评价指标。[结果]23例术前经影像学检查排除肿瘤、结核等椎管内占位患者,术后病理学证实均为椎管内炎性肉芽肿。手术均顺利完成,平均手术时间为(91.07±12.74)min,出血量为(102.14±35.34)ml,均未给予输血,VAS评分由术前的(6.93±1.14)分降到末次随访的(2.79±0.70)分,Frankel脊髓损伤等级分别由术前的C级1例、D级12例、E级10例改变为末次随访的D级1例、E级22例。[结论]对诊断为椎管内占位并伴有症状及功能障碍且排除肿瘤、脊柱结核的椎管占位性病变,疑为椎管内炎性肉芽肿的患者,行手术病灶清除植骨融合是治疗的有效方法。不仅可以清除占位的肉芽肿组织,且可以恢复脊柱序列,重建稳定性,术后可显著改善临床症状,恢复生活及自理能力。术前详尽的辅助检查、手术适应证选择及术中细致操作对保证患者术后恢复及临床疗效有重要作用。

[Objective] This study aimed to retrospectively analyze the diagnostic strategies,treatment options,and their clinical efficacy in patients with spinal inflammatory granuloma. [Methods] We included 23 patients who were admitted to our hospital because of spinal dysfunction symptoms. Laboratory and imaging studies were performed to exclude tumors,spinal tuberculosis,and other spinal lesions. The surgical indications were confirmed before posterior debridement graft fusion and internal fixation were performed. Pathological examination was performed after surgery. The clinical evaluation criteria included visual pain score（ VAS）,Frankel classification grade for spinal cord injury,and interbody fusion. [Results] Preoperative imaging studies excluded tumors and spinal tuberculosis in 23 patients. Inflammatory granuloma was confirmed in the postoperative pathological examination. All of the patients were successfully operated. The mean operative time was（ 91. 07 ± 12. 74） min,and the blood loss volume was（ 102. 14 ± 35. 34） ml,which did not require a blood transfusion. The VAS score of（ 6. 93 ± 1. 14） before surgery decreased to（ 2. 79 ± 0. 70） at last follow- up. Frankel grades for spinal cord injury of grade C in 1 and grade D in12 before surgery increased to grade D in 1 and grade E in 22 at the last follow- up time. [Conclusion] Surgical debridement and fusion is an effective method for suspected inflammatory granuloma of the spinal canal,with symptoms and dysfunction,and for exclusion of tumors,spinal tuberculosis,and spinal lesions. This method can not only remove granulomatous tissue but also reconstruct the instability damaged by inflammatory granuloma. Surgery can significantly improve symptoms and restore life and activities of daily living. Detailed laboratory examinations before surgery,criteria for surgical indications,and careful operation play important roles in ensuring recovery and postoperative clinical efficacy.