脊柱包虫病的诊断与治疗  

Diagnosis and treatment of spinal hydatid disease

作　　者：李岩[1] 崔泳[1] 郭梅香[2] 李冠霖[3] 

机构地区：[1]新疆医科大学第五附属医院骨科,乌鲁木齐市830011 [2]新疆医科大学第五附属医院预防保健科,乌鲁木齐市830011 [3]新疆医科大学第一附属医院骨科,乌鲁木齐市830000

出　　处：《中国脊柱脊髓杂志》2012年第7期607-611,共5页Chinese Journal of Spine and Spinal Cord

摘　　要：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.

关 键 词：脊柱包虫病 细粒棘球蚴 泡状棘球蚴 诊断 治疗 

分 类 号：R681.5[医药卫生—骨科学] R532.32[医药卫生—外科学]