病灶清除植骨融合术治疗脊柱包虫病的疗效

Clinical outcome of debridement and bone graft fusion for treatment of spinal hydatid disease

[目的]观察病灶清除植骨融合术在脊柱包虫病临床治疗中的效果。[方法]回顾性分析2006年1月~2014年12月本院收治的6例脊柱包虫病患者,其中胸椎3例(T8、T10~12、T11~12),胸腰段2例(T10~L1、T12~L1),腰椎1例(L1~L2)。术前行包虫酶联免疫吸附试验,3例阳性。术前ASIA脊髓损伤评分B级1例,C级3例,D级1例,E级1例。术前影像学检查误诊为脊柱结核2例,椎体转移瘤1例。所有病例均行手术治疗,均采用椎体侧后方病灶清除并一期植骨融合椎弓根螺钉内固定术,其中2例复发后采用前路再次病灶清除植骨融合。6例均行病理检查确诊包虫病,其中细粒棘球幼3例,泡性棘球蚴3例,术后均给予阿苯达唑治疗6个月。[结果]所有病例均获随访,随访时间1~7年,平均3.7年,平均手术时间(213.13±47.88)min,平均失血量(913.75±214.67)ml,术后引流量(353.75±90.07)ml,术后完全负重时间(8.50±2.33)周。术后2例出现复发,接受二次手术,其中1例随访5年后病故,1例术后出现切口感染,经二次手术后痊愈。其余植骨病例最终均达到植入骨骨性融合,植骨融合时间(4.50±3.30)个月。末次随访时ASIA脊髓评分与术前相比神经功能改善1~2级。[结论]手术是目前治疗脊柱包虫病的主要方法,病灶清除植骨融合对脊柱包虫病治疗有效,但多节段、混合型脊柱包虫病复发率较高,术中防止囊壁破裂及完整切除病灶对防止复发尤为重要。

[Objective] To observe the clinical outcomes of debridement and bone graft fusion for treatment of spinal hydatid disease. [Methods] Six patients with spinal hydatid disease were admitted in our hospital between January 2006 and December 2014. The lesions involved the thoracic segments in 3 cases （T8, T10-12, T12-12 respectively）, the thoracolumbar segments in 2 cases （T10 - L1, T12-L1. respectively）, and the lumbar segment in 1 case （L1-2）. The enzyme linked immunosorbent assay showed positive results in 3 cases. According to ASIA standard for spinal cord injury, 1 patient was graded as Grade B, 3 as Grade C, 1 as Grade D and 1 as Grade E. Before surgery, 2 patients were misdiagnosed as spinal tuberculosis and 1 case as vertebral metastases by imaging examination. All the 6 patients were confirmed hydatid disease by pathological tests, including 3 cases of echi- nococcosis granulose disease, 3 cases of alveolar echinococcosis disease. All the patients were treated with posterior debridement, bone autograft fusion and pedicle screw fixation at one stage. After surgery, all cases received the treatment of albendazole for 6 months. [Results] All patients were followed up from 1 to 7 years with an average of 3.7 years. The surgical procedure lasted for （223.23±47.88） min with intraoperative blood loss of （913.75±224.67） ml on average. The postoperative drainage volume was recorded as （353.75±90.07） ml. The full weight-bearing achieved at （8.50±2.33） weeks after operation. Two patients re- curred underwent the secondary anterior debridement and fusion, one of them died after 5 years, the other one experienced post- operative wound infection which healed by proper treatment. The remaining 4 patients achieved complete bony fusion （4.50±3.30） months after operation. At the latest follow-up, ASIA neurological classification of spinal cord injury improved by 2-2 grades. [Conclusion] Debridement and bone graft fusion are the main treatment for spinal hydatid disease. However, recurrence rate is high in cases with multiple segments involved and mixed-types. It is important to debride the lesion completely without cyst wall rupture during surgery for prevention of reoccurrence,